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Flashcards in Pediatric endocrine Deck (23):
1

Characteristics of Type 1 Diabetes mellitus

Acute onset,
Human leukocyte antigens (HLA-DR3 or HLA-DR4) strongly associated
Destruction of pancreatic islet cells by islet cell antibodies (autoimmune process)
KETONES IN BLOOD AND URINE

2

labs/ diagnostics for type 1 diabetes mellitus

-serum fasting >126 on 2 separate occasions
-random blood sugar >200 and polydipsia, polyuria and weight loss indicate the need to confirm the diagnosis by fasting studies
-glucosuria and ketonuria
-plasma ketones
- serum BUN and cr
-elevated hgb a1c 5.5-7%
-impaired glucose tolerated test IGT, fasting blood glucose fbg>100 and

3

what dose should insulin start in type 1 patients with KETONES

0.5units/kg/day, giving 2/3 in the a.m. and the remaining 1/3 in the evening

4

The Somogyi effect

morning hyperglycemia due to nocturnal hypoglycemia. Tx is to reduce HS dose

5

The dawn phenomenon

Early morning hyperglycemia because tissue becomes desensitized to insulin nocturnally (due to GH?). Tx: add or increase HS insulin

6

Signs associated with insulin resistance

acanthosis nigricans
HTN
Dyslipidemia
Polycistic ovarian disease

7

What age do you begin screening for diabetes

age 10 or onset of puberty and repeat every 2 years

8

s/sx of DM II

insidious onset
generalized puritis
recurrent vaginitis
peripheral neuropathies
recurrent blurred vision
Chronic skin infections
acanthosis nigricans
polydipsia, polyphagia, polyuria may be present

9

Lab difference in type II than type I diabetes

THERE WILL BE NO KETONES in blood/ urine

10

What is the only oral anti diabetic medication approved for use in children and what are its directions?

Metformin
850mg BID or 500mg TID
MOA: reduces gluconeogenesis
not to be given in renal or hepatic failure or those prone to hypoxia
Significant GI upset
No hypoglycemia
needs to be discontinued 48 hours before a procedure

11

What is the negative feedback loop for thyroid hormones

The hypothalamus releases TRH> anterior pituitary, which releases TSH> Thyroid gland which releases t3 and t4

If the thyroid is releasing too little t3 and t4, it will signal the anterior pituitary to release more TSH or the hypothalamus to release more TRH

If the thyroid is releasing too much t3 and t4, it will signal the anterior pituitary to release less TSH or the hypothalamus to release less TRH

12

Labs for hypothyroidism

decreased t4 and free t4, increased TSH

13

labs for hyperthyroidism

increased t3 and t4, decreased TSH

14

graves disease

enlarged and overactive thyroid, antibodies.

15

What is the most important test for hyperthyroidism?

t4

16

What is the most sensitive test for hyperthyroidism?

TSH

17

Medications included in the regimen for hyperthyroidism

propranolol symptomatically, thiourea drugs (PTU and tapazole), radioactive iodine (131-I)

18

Causes of hypothyroidism

Most commonly autoimmune thyroiditis (hashimotos)
disease of the thyroid gland itself
deficiency of the pituitary thyroid stimulating hormone (TSH) or TRH
Iodine deficiency
deficient pituitary
Destruction of thyroid gland by surgery or radiation or trauma

19

s/sx of hypothyroidism is newborns/ infants

not obvious
Is in newborn screening (mandatory)
lethargy, poor feeding
prolonged biliruben elevation
growth deceleration
large fontanels
bradycardia
hypotonia

20

definition of short stature

Height falling >2 standard deviations (SD) below mean, or a marked deviation from previously established growth curve
Failure to grow more than 4cm per year

21

management of childhood thyroid

refer to endocrine

22

lab findings with hypothyroidism

decreased t4 and free t4, elevated TSH, Increased cholesterol and liver enzymes, hyponatremia, hypoglycemia, anemia

23

What kind of growth delay should not be given GH

consitutional delay; bone age consistent with height age