Endocrinology q-bank Flashcards
(79 cards)
Which antibodies are most commonly seen in Hashimoto thyroiditis?
Thyroid antiperoxidase antibody (anti-TPO) and antithyroglobulin antibody seen in 90% of patients
What should you consider in a patient with hypoparathyroidism, Addison’s, recurrent candidiasis and skin changes?
APCED Auto-immune polyendocrinopathy ectodermal dysplasia - autoimmune polyendocrinopathy, candidiasis, ectodermal dysplasia
With nephrogenic DI, what is the most common inheritance pattern? Name 4 acquired causes of nephrogenic DI.
X-linked, some forms can be AD or AR Acquired causes: hypercalcemia hypokalemia lithium rifampin methicillin kidney disease
In physiologic adrenarche, describe: - age at which acceptable - what blood / urine markers are seen - bone age findings - long-term prognosis - tests to perform if unsure if physiologic
Adrenarche (increase in adrenal steroids) resulting in hair, body odour and skin changes and maybe slight growth acceleration but no other signs of puberty - 6 years of age in boys and girls - rise in DHEAS, urine 17-ketosteroids (hydroxysteroids normal) - bone age on upper end of normal - more likely to develop PCOS or hyperandrogenism - ACTH stim test with 17-OHP (rule out atypical CAH)
What is Russel-Silver syndrome?
A growth disorder from before and after birth: LBW & FTT, normal head size Low appetites and at risk of hypoglycemia Small triangular face, prominent forehead, downturned corners of mouth Delayed development, learning disabilities
What type of growth are these curves showing?

Constitutional delay of growth and adolescence
What form of growth?

Familial or genetic short stature
What form of growth?

Primary nutritional or severe chronic illness
What form of growth?

Congenital GH deficiency :)
Name a possible syndrome associated with this type of growth

Turner’s
What is the calculation for expected height range in kids?
(based on parents)
(Mum’s height + dad’s height) +/- 13cm if boy/girl
divided by 2
Range calculated as +/- 10cm
What is the rate of growth in both sexes?
4-7 cm/year
When are kids ‘allowed’ to cross percentile lines on the growth chart?
1- within first three years of life while finding their fit (ie: small infants to large parents and vice versa)
2- at puberty (accounting to different start times of growth spurts)
What is IGF1?
Insulin like Growth Factor 1
factor produced by growth hormone’s effect on the liver
What is the significance of bone age?
Where to measure?
Most conditions that cause poor linear growth also cause a delay in skeletal maturation and retarded bone age, it indicates that the short stature is to some extent reversible.
A bone age that is NOT delayed is of greater concern and can be diagnostic ie: syndromes, achondroplasia, rickets
Measure at hand and wrist epiphyseal maturation centers
What investigations to consider in a well nourished child with a deceleration in linear growth?
TSH, T4
bone age
karyotype if female
IGF-1, IGFB3
(if considering glucocorticoid excess: 24h urinary free cortisol & creatinine)
Approach to decelerating linear growth in a thin child?
Consider primary GI, nutritional, renal or other systemic chronic disease:
CBC w/ ESR
TTG
electrolytes
first morning void
What findings suggest growth hormone deficiency:
in the neonate? (try 4)
in the child? (try 3)
neonate: 1- hypoglycemia, 2- prolonged jaundice, 3- hepatitis, 4- microphallus, 5- traumatic delivery
child: 1- cranial irradiation, 2- head trauma or CNS infection, 3- cosanguinity or affected family member, 4- craniofacial midline abnormalities
What growth findings would suggest GH deficiency?
severe short stature (< 3 SD below)
height < 2 SD and height velocity <1 SD
Indications for GH treatment approved by FDA
GH deficiency
Turner’s
Chronic Renal Failure
Idiopathic short stature
SGA with short stature
Prader Willi
Define central precocious puberty & tests to investigate
Onset of secondary sexual characteristics:
development on breasts before the age of 8 in girls
development of testicular volume >4mL before the age of 9 in boys
Order bone age, FSH/LH/estradiol/testosterone
If +ve, consider GnRH stim test and cranial imaging in boys or girls <6yo
Who do you worry more about with precocious puberty, girls or boys?
BOYS!
90% of girls have the idiopathic form
75% of boys will have a structural CNS abnormality
How do you treat central precocious puberty?
(assuming work-up negative)
GnRH agonist in order to disrupt pulsatility
ie: Leuprolide acetate (Lupron)
Actual adult height of patients followed is 1 SD less than mid-parental height
What is the most common form of congenital adrenal hyperplasia?
What lab findings?
‘Salt-losing form’ 70% of CAH
21-hydroxylase deficiency (90% of CAH cases) therefore accumulation of 17-OHP as it can’t be converted to 11-deoxycorticosterone and 11-deoxycortisol (aldosterone and cortisol precursors)
Presents with hyponatremia, hyperkalemia, hypoglycemia, metabolic acidosis, vomiting, lethargy, shock at 10-14 days of age