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Flashcards in Endocrine Deck (25)
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1

Type I Diabetes mellitus presentation

<19 yo

Polyuria, polydipsia, nosturia

Weight loss, lethargy

DKA is often the initial presentation (anorexia, nausea, vomiting, dehydration, stupor, and,
ultimately, coma)

2

Type I Diabetes mellitus pathophys

Pancreatic β cells fail to repsond to stimuli and undergo autoimmune destruction

3

Type I Diabetes mellitus w/u

Difrentiate from DM2 by islet auto Ab screen

Random plasma glucose >200 mg/dL w/classic sx or fasting levels of ≥126 mg/dL on more than one occasion is diagnostic

HbA1c reflects glycemic control over the preceding 8-12 wks, ≥6.5% is diagnostic of DM

4

Type I Diabetes mellitus tx

Formal training and education using a diabetes team

Intensive insulin regimen

Address depression and anxiety

Annual urine microalbumin

Ophtho visits at age 10 or after 3-5 years of diagnosis

Lipid screens

Periodic autoimmune thyroid and celiac screening

5

Type II Diabetes mellitus pathophys

Distribution of fat to the upper body (central obesity) is assoc w/ highest risk

The basic physiology is twofold:
insulin resistance to β cell–produced insulin and relative insulin deficiency, especially with dz progres- sion

Resistance is ↑ with aging, sedentary lifestyle, and abdominovisceral obesity

6

Type II Diabetes mellitus presentation

DKA

Hyperglycemia w/o ketonuria

Polyuria, polydipsia

Lethargy

Often occurs at onset of puberty as this causes ↑ insulin resistance

7

Type II Diabetes mellitus w/u

Random glucose >200 mg/dL (w/ sx), fasting glucose ≥ 126 mg/dL on more than one occasion or HbA1c ≥ 6.5%

Differentiate from DM1 by presence of excess weight, acanthosis nigricans, HTN, dyslipidemia, PCOS, FH, ethnic group risk factors

Screen at risk children with BMI > 85th percentile and 2+ additional risk factor screen q 3 years

8

Type II Diabetes mellitus tx

Treat co-morbidities

If asymptomatic → lifestyle Δ only w/ wt loss and ↑ activity → if noimprovement → metformin

If severe → begin insulin then wean off to metformin

Screen for HTN, dyslipidemia, NAFLD

Annual ophtho visits

Annual microalbumin screens

Annual diabetic neuropathy screens

9

Overweight BMI

BMI 85-95th percentile

25-29.9

10

Obese BMI

BMI > 95th percentile

30-34.9

11

Severe obesity BMI

BMI > 120th percentile or BMI > 35

12

Obesity tx

Refer all obese children < 2 to a specialist

Tx for underlying eating disorders

Firm limits on screen time

Establish habitual physical activity

Educational handouts

13

Hypercalcemia common causes

MC caused by lunc ca, SCC of head, neck and esophagous, MM, lymphoma, RCC

Can also be caused by vitamin D intoxication, hyperparathyroidism, and sarcoidosis

14

Hypercalcemia presentation

Asymptomatic until >12 mg/dL

Anorexia, nausea, constipation, polyuria, polydipsia, dehydration, Δ in consciousness (lethargy, stupor, coma)

Orthostatic hypotension, tachycardia

15

Hypercalcemia w/u

Serum Calcium high

Corrected calcium = meas total calcium + [0.8 (4 x albumin)]

Chest radiography → underlying pulm mass

UA to checm for hematuria (an early sign of RCC)

24 hr urine Calcium → if elevated urine calcium → malig neoplasm or paraneoplastic process, if dec urine ca → hyperparathyroidism

16

Hypercalcemia tx

Isotonic saline forvol depletion

Loop diuretics if the pt is
hypervolemic after vol repletion
Bisphosphonates can also be considered in severe hypercalcemia

Manage the underlying cause

17

Hyperthyroidism presentation

Weight loss despite good intake

Anxiety, warm, moist skin, onycholysis, insomnia

Fine tremor, fatigue, muscle cramps, weakness

Women report menstrual irregularity

Tachycardia, palpitations, PVC, forceful heartbeat

Δ in bowel pattern, menorrhagia, brittle hair, heat intol, hyperreflexia

3% of pts experience pretibial myxedema

18

Hyperthyroidism w/u

↑ T3 and free T4

Low TSH levels

Peroxidase Ab and thyroglobulin Ab are + in Graves dz but not toxic multibodular goiter

19

Hyperthyroidism tx

β- blockers (propranolol) to control sx (tachycardia, termor, diaphoresis, anxiety, palpitation)

PTU (good forpregnancy or breast feeding) and MMI

Check TSH levels in 4-6 wks

Thyroidectomy, radioactive iodine ablation, iodinated contrast agents (temporart)

20

Hypothyroidism presentation

Weakness, dry or coarse skin, lethargy, slow speech, cold intolerange, eyelid edema, forgetfulness, facial edema, constipation, coarse hair, weight gain, facial dullness, depression, anemia, brdycardia, hyporeflexia

Palpable diffusely enlarged thyroid w/ fine nodules is often presnet

21

Hypothyroidism w/u

Primary: ↑ TSH, ↓ T4

Secondary: low or nrml TSH and ↓ T4

Antithyroid peroxidase and antithyroglobulin Ab in serum confirms autoimmune

Hyponatremia

22

Hypothyroidism tx

Levothyroxine 25-200 micrograms QD

T4 needs inc in 3rd trimester of preg and with some meds

Once stable check levels twice yearly

23

Short stature presentation

Apparent b4 2nd yr of life

Manifests as deceleration in height

Height closely matches parental height

Nml devel w/o toher signs or sx of dz

24

Short stature w/u

CBC, ESR, US, BUN and Cr, serum electrolytes including Ca2+ and phos, exam of stool for fat, karyotype, IGF and IGT-binding protein 3

Radiography of distal radius will reveal bone age = to chronological age

25

Short stature tx

Reassure parents that deceleration is normal and expected, especially if both parents are short.