Endocrine/Metabolic Paeds Flashcards
(30 cards)
CONGENITAL HYPOTHYROIDISM Causes
- Thyroid dysgenesis: agenesis, hypoplasia, ectopia
- Dyshormonegenesis
- Thyroidoglobulin defect
- Transient hypothyroidism
- Hypothalamic/pituitary abnormality
- Rares causes, including endemic cre<nism
Symptoms CONGENITAL HYPOTHYROIDISM
- Cons<pa<on
- Feeding problems
- Lethargy
- Respiratory signs and/or symptoms
Signs CONGENITAL HYPOTHYROIDISM
- Hoarse cry
- Neonatal jaundice
- Facial puffiness
- Enlarged protruding tongue
- Umbilical hernia
- CNS:
- Spas<city
- Tremor
- Ataxia
- SNHL
Causes ACQUIRED HYPOTHYROIDISM
- 1°:
- Hashimoto’s thyroidi<s
- Fe-deficiency
- Removal of thyroglossal duct
cyst - Rx for thyrotoxicosis
- Goitrogens Drugs: lithium,
amiodarone - Infiltra<on
- Liver haemangioma
- Central: any acquired hypothalamic-pituitary causes
Symptoms ACQUIRED HYPOTHYROIDISMz
Symptoms
* Cons<pa<on
* Weight gain
* Tiredness
* Poor school performance
* Cold intolerance
* Menstual irregularity
ACQUIRED HYPOTHYROIDISM Signs
- Goitre
- Pallor
- Dry skin
- Brible/sparse hair
- Myxoedema
- Short/slow growing
- Proximal muscle weakness
- Delayed relaxa<on of the tendon
reflexes - Ruberty: early or delayed
Hypoglycaemia
Hgt when physiological neurological dysfunc6on begins
Pathophysiology HYPOGLYCAEMIA
- In the fas6ng state: glucose is produced by glycogenolysis & gluconeogenesis
- Glucose u6lisa6on as major energy source is mainly under the influence of
insulin
Neuroglycopaenic symptoms Hypoglycaemia
- Headahce, visual disturbances,
drowsiness & coma, convulsions
INSULIN DEPENDANT DM Associa)on with other autoimmune condi)ons:
Hashimoto thyroidi)s
Type A gastri)s
Coeliac disease
1° adrenal insuffiency
INSULIN DEPENDANT DM sx
- Polydipsia
- Polyuria (enuresis &
nocturia)
Can present in DKA - Polyphagia
- Poor weight gain/LOW
- Abdominal pain ± vomi)ng
- Fa)gue, irritability, ! school performance
- Blurred vision (osmo)c swelling of the lens)
- Calf cramps
- Candida vagini)s: pruri)s vulvae
- Recurrent skin infec)ons & poor wound
healing
Dx INSULIN DEPENDANT DM
- Symptoms
- Heavy glycosuria: > 55 mmol/L
- Random plasma glucose ≥ 11.1 mmol/L
Fas)ng plasma glucose ≥ 7 mmol/L
Acute Complica6ons INSULIN DEPENDANT DM
Hyperglycaemic crisis: DKA or HONK
Life-threathening hypoglycaemia
Chronic Complica6ons INSULIN DEPENDANT DM
- Microvascular:
5-10 years aner onset of disease
▪ Nephropathy
▪ Re)nopathy
▪ Neuropathy
▪ Diabe)c foot - Macrovascular (more in DM II):
▪ CHD
▪ Cerebrovascular disease
▪ Peripheral artery disease
▪ Monckeberg atherosclerosis - Diabe)c cardiomyopathy
- Diabe)c famy liver disease
- Hyporeninemic hypoaldosteronism
- Limited joint mobility
- Sialadenosis (enlargement of salivary gland)
- incr risk of infec)on: decr immunity, poor )ssue perfusion & incr growth
of bacteria & fungi
DIABETIC KETOACIDOSIS Etiology
- Undiagnosed, untreated DM
- Rx failure in known diabe5cs
- stress : Infec5ons
Surgery
Trauma
MI - drugs : Glucocor5coid therapy
Alcohol or cocaine use
Symptoms DKA
- Polyuria (osmo5c diuresis) & polydipsia
- Recent LOW
- Nausea & vomi5ng ! expels gastric acid
- Abdominal pain (ketoacidosis leads to irrita5on of the peritoneum)
Signs DKA
Rapid onset (< 24 hours)
* Toxic/febrile
* Fruity odor on the breath (exhaled acetone)
* Kausmall’s breathing (respiratory compensa5on)
* Signs of volume deple5on, hypotension, circulatory collapse
* Neurological abnormali5es:
- Changed consciousness
- Lethargy
- Blurred vision & weakness
- Coma
Mx DKA
- Fluids
- Potassium
- Insulin
- Sodium bicarbonate
Non-resolving acidosis in DKA, WHAT TO CONSIDER?
- Sepsis
- Check drip site & patency
- Check if all bags are running
- Enough fluid: adequate resus
- Replace urine loss
- Consider acidosis due to hyperchloraemic acidosis
- Consider INCR insulin infusion rate > must be discussed with consultant
Sx of cerebral oedema
- Headache
- Change in vitals: decr HR, incr BP, decr sats, fever
- Change in CNS signs: decr LOC, irritability, restlessness, CN palsies
PRECOCIOUS PUBERTY
Girls = 2° sexual characteris1cs < 8 y/o
Boys = 2° sexual characteris1cs < 9 y/o
PRECOCIOUS PUBERTY problems
- Short adult height
- Psychological
- Prac1cal
- LBW
- PCOS in teens
- PH, clitoromegaly
- Premature babies
- Exclude CAH, adrenal & ovarian tumours
RICKETS
= failure to mineralise newly-formed bone
Occurs in children where epiphyses have not yet fused
Causes of Rickets
Causes
* Vit D deficiency; foetal level is influence may mom’s vit D status
* Abnormal vit D metabolism
* Lack of Ca2+
* Lack of PO4
* decr ALP
