Paediatric aspects of diabetes and endocrinology

Question 1

How common is type 1 diabetes

Answer 1

250 children attend the paediatric diabetes service
one of the most common chronic diseases seen in children
Becoming more common

Question 2

What is the incidence of type 1 diabetes in children

Answer 2

1 in 450

Question 3

In 25% of new cases, what is the presentation for type 1 diabetics

Answer 3

DKA

Question 4

What are 4 classic symptoms of type 1 diabetes

Answer 4

polyuria
polydipsia
weight loss
general malaise

Question 5

What are symptoms of DKA

Answer 5

vomiting 
abdominal pain
altered consciousness
acidotic breathing 
dehydration

Question 6

What would a fasted blood glucose level be to suggest type 1 diabetes

Answer 6

7 or more

Question 7

What would a random blood glucose level be to suggest type 1 diabetes

Answer 7

11 or more

Question 8

If DKA is left untreated what can it lead to

Answer 8

Coma and death

Question 9

What would be seen in urinalysis in DKA

Answer 9

pH

Question 10

What are some of the other risks/ problems of type 1 diabetic children

Answer 10

Based on weight (10ml/kg)
careful fluid resuscitation
risk of cerebral oedema
insulin commenced 1 hour after IV fluids started

Question 11

What are some of the early changes of vascular diabetes in children with type 1 diabetes

Answer 11

microalbuminuria
cardiovascular autonomic neuropathy 
sensory nerve damage
retinopathy
cheirarthropathy
skin vascular changes
vascular endothelial pathology

Question 12

In what way can we achieve optimal glycaemic control in type 1 diabetes

Answer 12

Early intensification - multiple daily injection, pumps, insulin adjustment from the start
consistent approach
consistent targets
good support - friends, school, family

Question 13

What part of the body is faulty in primary thyroid disease

Answer 13

thyroid gland

Question 14

What part of the body is faulty in secondary thyroid disease

Answer 14

Pituitary

Question 15

What part of the body is faulty in tertiary thyroid disease

Answer 15

Hypothalamus

Question 16

What is secondary/ tertiary thyroid disease usually associated with

Answer 16

hypopituitarism

Question 17

What are some clinical symptoms that may be present in congenital thyroid disease

Answer 17

delayed jaundice
poor feeding, but normal weight gain
hypotonia
skin and hair changes

Question 18

What is the test performed for congenital thyroid disease

Answer 18

Guthrie Test

Question 19

How is the Guthrie test performed

Answer 19

On day 5 of after birth
capillary blood on dry blotting paper
Test for TSH and T4

Question 20

Why is the Guthrie test not performed immediately at birth?

Answer 20

The TSH and T4 levels take a few days to normalise

Question 21

How can we diagnose congenital thyroid disease

Answer 21

Absence of thyroxine in the first 2 weeks of life

Question 22

Why does a foetus appear normal who has congenital disease

Answer 22

They have been protected by placental thyroid hormones

Question 23

What is a major complication of congenital thyroid disease

Answer 23

Developmental delay

Question 24

what type of disease is acquired thyroid disease

Answer 24

Autoimmune

Question 25

What are some symptoms of hypothyroidism in children

Answer 25

``` Growth failure delayed puberty poor general health educational difficulties goitre ```

Question 26

What would be the results of thyroid function tests in hypothyroidism

Answer 26

Low free T4 and T3 High TSH High thyroid cell antibody titres

Question 27

What is the treatment for hypothyroidism in children

Answer 27

Thyroxine replacement for life | Dose depends on the size of the child

Question 28

What are some of the general symptoms of hyperthyroidism

Answer 28

``` Behaviour problems Sleep disturbance eating difficulties Goitre high pulse rate precocious puberty ```

Question 29

What would the results of the thyroid function test be in a patient with hyperthyroidism

Answer 29

Suppressed TSH high free T4 and T3 levels high thyroid cell antibody titres

Question 30

What is the initial treatment for hyperthyroidism

Answer 30

Beta blockade

Question 31

What is the treatment for suppressant therapy in hyperthyroidism

Answer 31

Carbimazole +/- thyroxine

Question 32

What are some permanent treatment strategies for hyperthyroidism

Answer 32

Radio-iodine or surgery

Question 33

What is more common in children- hypothyroidism or hyperthyroidism

Answer 33

Hypothyroidism

Question 34

If a patient has an underachieve adrenal gland, what do they produce low doses of

Answer 34

Steroids

Question 35

What is the main cause of primary adrenal disease

Answer 35

Congenital adrenal hyperplasia

Question 36

What is also known as overactive production of steroids

Answer 36

Cushing syndrome

Question 37

What is the treatment for Cushing disease

Answer 37

cortisol therapy

Question 38

What are signs of Virilisation in males and then in females

Answer 38

Males - precocious puberty | Females - ambiguous genitalia