Endocrinology Flashcards
(43 cards)
What is the presentation of T1DM?
DKA
Polyuria and polydipsia
Weight loss and fatigue
Secondary enuresis
Recurrent infections
What are the ix into a new diagnosis of T1DM?
If fever = cultures.
FBC, U+E, BM, HbA1c, TFTs and TPO, anti TTG, insulin ab
What is needed for diagnosis of T1DM?
Random BM >11mmol/L or fasting glucose >7mmol/L w sx or x2 bloods over 2 weeks
What is the management of T1DM?
SC insulin - background, long or short acting, SC or admin by pump, basal bolus
Screen for complications.
What are the sx of hypoglycaemia?
Hunger, sweating, tremor, irritability, dizzy, pale
Severe - reduced conc, coma, death, seizure
What are some causes of hypoglycaemia?
Too much insulin
Not enough carbs or not processing carbs properly eg. malabsorption, diarrhoea, vom and sepsis
Not T1DM related - hypothyroidism, GH def, liver cirrhosis, fatty acid oxidation defects
What is the management on hypoglycaemia?
If conc - oral rapid acting glucose and slower acting carbs
Not conc - IV dextrose, IM glucagon
What are the long term complications of T1DM?
Macrovascular - coronary artery disease, diabetic foot, stroke HTN
Microvascular - neuropathy, retinopathy, nephropathy
Recurrent infection
What are some options for monitoring T1DM?
- HbA1c - shows control over last 3 months
- Cap blood glucose - immediate result
- Freestyle libre - sensor
What is the presentation of congenital hypothyroidism?
Screened at birth in newborn blood spot screening test but:
- Prolonged neonatal jaundice
- Poor feeding
- Constipation
- Increased sleeping
- Reduced activity
- Slow growth and develop - undiagnosed can cause ID
What is the presentation of acquired hypothyroidism?
Hashimotos autoimmune thyroiditis, associated w anti TPO ab and T1DM and coeliacs:
- Fatigue and low energy
- Poor growth
- Weight gain
- Poor school performance
- Constipation
- Dry skin and hair loss
What is they management of hypothyroidism?
Ix - TFTs, thyroid US and thyroid ab
Levothyroxine every day
What is the pathophysiology of DKA?
No glucose in tissues so ketogenesis is started = ketone acids in the blood, kidneys produce bicarb to buffer but after a while = no bicarb and blood acidic = ketoacidosis.
Glucose in urine = osmotic diuresis = polyuria = dehydration.
K+ not added to cells as no insulin so is left in blood = hyperkalaemia
What are the features of DKA?
- Hyperglycaemic - >11mmol?l
- Ketoacidosis - acidic blood >3mmol/L ketones and pH <7.3
- Potassium imbalance - hyperkalaemia
What is the presentation of DKA?
Polyuria and polydipsia
N+V
Weight loss
Acetone breath
Dehydration and hypotension
Alt conc
Sx of underlying trigger
What are the principles of DKA management in children?
- Correcting dehydration over 48 hours - dilutes ketones and hyperglycaemia
- Fixed rate insulin infusion
- Avoid fluid bolus to reduce risk cerebral oedema
- Prevent hypoglyaemia if needed
- Give K w fluids and insulin
What are some potential problems w treating DKA?
- Hypokalaemia - insulin drives K+ into cells, could do this suddenly when give insulin = arrhythmia and death
- Cerebral oedema - dehydration and high BM = water leaves cells in brain, rapid correction of dehydration and hyperglycaemia = rapid shift of water into brain cells = oedema
What are some warning signs of cerebral oedema in DKA?
Headache
Alt behaviour
Brady
Reduced conc
What is adrenal insufficiency?
Adrenal glands don’t produce enough cortisol and aldosterone
Primary adrenal insufficiency = Addison’s, mainly autoimmune
Secondary adrenal insufficiency = not enough ACTH
Tertiary adrenal insufficiency = not enough CRH from hypothalamus = not enough ACTH = not enough cortisol, normally caused by long term steroid use
What are the features of adrenal insufficiency in babies?
Lethargy
Vomiting
Poor feeding
Hypoglycaemia
Jaundice
Failure to thrive
What are the features of adrenal insufficiency in older children?
N+V
Poor weight gain or weight loss
Reduced appetite
Abdo pain, muscle weakness, cramps
Develop delay
Bronze hyperpigmentation to skin caused by high ACTH levels which stim melanocytes
What are the ix into adrenal insufficiency? What are the biochemical features?
Addisons - low cortisol, high ACTH, low aldosterone, high renin
Secondary adrenal insufficiency - low cortisol and ACTH, normal aldosterone and renin
Check U+E, BM
ACTH stim test
What is the ACTH stim test?
Performed in the morning, give synthetic ACTH, if adrenal glands are normal the synthetic ACTH will increase cortisol, should at least double.
If doesn’t rise = Addison’s
What is the management of adrenal insufficiency?
Cortisol = hydrocortisone
Aldosterone = fludrocortisone
Steroid card and emergency ID tag - can’t stop steroids suddenly and need to increase steroids during illness
