Endocrinology/Growth - Hypoglycaemia/Growth&Puberty Flashcards
(29 cards)
Why is hypoglycaemia a problem in the neonatal period?
- first 24 hours of life in babies with intrauterine growth restriction or preterm - poor glycogen stores
- born to mothers with diabetes mellitus - sufficient glycogen but hyperplasia of islet cells in pancreas leading to high insulin
- large for dates
- hypothermic
- polycythaemic
- Ill
What are the symptoms of hypoglycaemia in neonates?
jitteriness irritability apnoea lethargy drowsiness seizures
What is the treatment for hypoglycaemia in neonates?
early and frequent milk feeding
if high risk then monitor blood glucose
if symptomatic or 2 low values give IV glucose
What are the causes of hypoglycaemia in children?
- fasting
- insulin excess e.g. diabetes mellitus, insulinoma
- drug induced (sulphonylurea)
- autoimmune - insulin receptor antibodies
- liver disease
- hormone deficiency (low GH, low ACTH) etc
- galactosaemia
- maternal DM
- aspiration/alcohol poisoning
What are the symptoms of hypoglycaemia in children?
sweating
pallor
CNS symptoms - irritability, headache, seizures, coma
If persists - epilepsy, severe learning disabilities and microcephaly
What investigations should be carried out when hypoglycaemic?
lab blood glucose
Bloods - GH, IGF-1, cortisol, insulin, C-peptide, fatty acids, ketones, glycerol, amino acids, acylcarnitine, lactate, pyruvate
Urine - organic acids, toxicology
What is the treatment for hypoglycaemia?
Glucose in the form of tablets Non-diet sugary drink Oral glucose gel IV glucose Glucagon injection - IM if severe Corticosteroids is possibility of hypopituitarism or hypoadrenalism
What is the epidemiology of insulin dependent diabetes in childhood?
2/1000 children by 16 years
How does insulin dependent diabetes present in childhood?
two peaks of presentation - preschool and teenagers
few weeks of polyuria, polydipsia and weight loss
young children may develop secondary nocturnal enuresis
What are the non medical treatment options for childhood diabetes- IDDM?
education for parents and children
diet changes - reduced carbs, <30% fat, high fibre
finger prick monitoring - in case of adjustments to changes of lifestyle, food and exercise
blood ketone monitored when ill
What is the medical treatment options for IDDM?
- Insulin – continuous infusion by pump or injections by syringe + needle/pen-like devices/jet injectors
- Inject into upper arm/ant or lat thigh/buttocks/abdo (rotate to prevent liphypertrophy)
- Usually basal-bolus
- Need for supportive school environment
What are the short term complications of IDDM?
- Hypoglycaemia – hunger, tummy ache, sweatiness, feeling faint/dizzy or ‘wobbly feeling’ in legs
- Can progress to seizures/coma
- Treatment = Administer glucose tablets or non-diet sugary drink (or gel if unwilling to eat)
What are the long term complications of IDDM?
- Diabetic retinopathy + nephropathy – good diabetic control can delay or prevent complications
- Growth + pubertal development – some delay of onset of puberty, obesity common if insulin dose not reduced towards end of puberty
- Hypertension – BP checked once a year
- Nephropathy – microalbuminaemia early sign
- Monitor for retinopathy + cataracts
- Feet – encourage good care + avoid tight shoes, treat infections early
- Coeliac + thyroid disease common
What are the presenting features of DKA?
DKA - blood glucose >11 mmol/L
- Smell of acetone in breath
- Vomiting
- Dehydration
- Abdo pain
- Hyperventilation due to acidosis
- Hypovolaemic shock
- Drowsiness
- Coma + death
How should DKA be managed?
initial resuscitation if in shock with normal saline, insert central venous line and urinary catheter
correct dehydration - monitor fluids, U&E, creatinine, acid-base status, neuro state
start potassium replacement as soon as urine passed
metabolic acidosis present
re-establish oral fluids
treat underlying cause
What is classified as short stature?
height below second centile
What are the pathological causes of short stature?
- familial
- IUGR and extreme prematurity
- constitutional delay in growth and puberty
- endocrine (usually child overweight) e.g. hypothyroidism, GH deficiency
- nutritional/chronic illness e.g. crohns/coeliac
- psychosocial deprivation
- chromosomal disorder e.g. downs/turners
- extreme short stature e.g. primordial dwarfism, resistance to GH
What are the important investigations when looking at growth delays?
Growth chart + compare measures of height with predicted height based on parental measures
Bone age may be useful
What are the important features of Russel-Silver syndrome?
not essential
born very small but normal head size
How do you calculate the mid parental height?
Girl = (½ dads height –12cm) + mum’s height Boy = ½ dad’s height + (mum’s height + 12cm)
When does puberty occur in girls?
8-13 years first sign = breast development pubic hair growth + rapid growth spurt menarche average about 2.5 years after start of puberty early adrenache RF for PCOS
When does puberty occur in boys?
9-14 years
first sign = testicular enlargement
pubic hair growth follows
later puberty could be hypogonadotrophic hypogonadism
Which syndromes affect growth?
Down’s
Turner’s– F with one functioning X choromosome. Short stature, premature ovarian failure. GH resistance
Laron’s Syndrome - GH insensitivity
Prader-Willi – constant hunger and slow metabolic rate. C’some 15
Soto’s/ Weaver’s -overgrowth syndrome but usually become normal-size adults
Russell-Silver Syndrome - born very small but normal-sized heads
What is precocious puberty?
Development of secondary sexual characteristics before 8 (females) and 9 (males)
