Paed Endocrine

Question 1

Overview of T1DM

Answer 1

-Mean age 12, 25% <5, 10% <2years.

-P: Toilet, tired, thirsty, thinner.

-D: Random blood glucose >11.1 mmol/l in presence of symptoms. Are they in DKA? Blood ketones/ capillary blood gas.

-M: If not, s/c insulin injections/ infusion

Question 2

Overview of DKA

Answer 2

Metabolic acidosis, Kussmaul breathing so low CO2/ normal. Treat dehydration, resus then slow, IV insulin and potassium supplementation.

Question 3

Overview of T2DM

Answer 3

-Rare in UK but incidence increasing.
-May present with classic symptoms (polyuria, polydipsia weight loss), DKA.
-Obesity, acanthosis nigricans FH
-Auto-antibodies and C-peptide
-May be treated with insulin initially (plus lifestyle modification, metformin, GLP-1 agonist)

Question 4

What is short stature?

Answer 4

-Common referral, 2% children, only minority will have pathology.
-Height less than 2 SDS below mean (less than 2nd centile) for age, gender, population.
-Accurate height, growth chart, serial measurements.
-Slower growth= more likely to have pathology, genetic background (parental target)

Question 5

Predicting height

Answer 5

Mid Parental height MPH): male ((MH+FH)/2) + 7, females -7. Target range +/- 10cm boys, 8.5 girls

Question 6

Stages of growth and their hormones

Answer 6

-Infancy (0-2): nutrition, GH/IGF-1
-Childhood to pre-puberty thyroxine and GH/IGF-1
-Puberty sex steroids and GH/IGF-1

Question 7

Female puberty

Answer 7

-Onset 8-13
-Breast buds
-2.5 years duration
-Height velocity increases early
-Menarche in later stages

Question 8

Male puberty

Answer 8

-Onset 9-14 years
-4ml+ testes start
-3-5 years duration
-Peak height velocity 8-10ml TV

Question 9

Causes of short stature

Answer 9

-GH related
-GH resistance
-Hypothyroidism
-Glucocorticoid excess: Cushing
-Congenital adrenal hyperplasia.
-Constitutional delay of growth
-Skeletal dysplasia
-Chronic disease

Question 10

Growth history

Answer 10

-Duration
-Severity
-Who is worried emotion or psychological
-Birth measurements?

Question 11

Growth exam

Answer 11

-Height, weight, head
-Proportions
-Broad chest or obesity
-Dysmorphism
-Systemic illness signs
-Hands and feet: short metacarpals, clinodactyly?

Question 12

Growth investigations

Answer 12

-FBC, UE, LFTF, CRP/ESR, Coeliac, TFT, LH, FSH, testosterone (oestradiol), IGF 1, bone age x-ray for growth plates for marker of how much growth left

Question 13

How to find cause of GH deficiency

Answer 13

-Insulin tolerance test: insulin induced hypoglycaemia stimulates GH secretion, overnight serum GH profile. GH deficiency- MRI for pituitary, other pituitary hormones