what should you consider in an infant who is born with hypoglycemia and a small penis (<2 cm in length)
panhypopituitarism
def. micropenis
stretched penile length of < 1.8 cm
healthy, full term newborn develops altered mental status w/in 48 hours of birth - what should you be considering?
- rule out sepsis - most common 2. inborn errors of metabolism i.e. urea cycle defect or organic acidemia
how can you differentiate between urea cycle defect and organic acidemia on initial labs?
urea cycle defect -severe hyperammonemia + resp alkalosis organic acidemia - mild hyperammonemia + metabolic acidosis
Symptoms: Neonatal hyperthyroidism
- jitteriness
- tachycardia
- HTN
- diarrhea
- poor feeding/poor weight gain
- exophthalmos
Tx. Neonatal Hyperthyroidism
- medical emergency!
- Methimazole inhibits the addition of iodine to thyroglobulin but does not block the release of preformed thyroxine or triiodothyronine (T3).
- Esmolol is a short-acting cardioselective beta-blocker with a rapid onset,; tx of tachycardia and HTN
- Iodine drops: blocks release of T3 and T4 and suppresses the activity of thyroid peroxidase.
- Glucocorticoids: reducing the conversion of T4 to T3 and, potentially, by decreasing the production of TSIs.
Infant with micropenis and hypoglycemia
- what are you worried about?
- next step in dx?
- panhypopituitarism
- measurement of non-stimulated gonadotropin and GH levels
Tx: Congenital Primary Hypothyroidism
Levothyroxine
- infants require higher doses than adults
- 10-15 ug/kg/day (vs 2-3 in adults)
- remeasure hormone levels 10-14 days after initiation to ensure TSH is normalizing
Which hormone should you measure to dx Vitamin D deficiency
25-hydroxyvitamin D
- storage form
Clinical Features: Addison’s Disease
- primary adrenal insufficiency.
- unexplained or severe hypoglycemia
- hyperpigmentation of the skin (even in sun protected areas) due to high levels of corticotropin activating the melanocortin-stimulating hormone receptor.
Diagnosis: Addison’s Disease
- early AM cortisol level
- An early-morning cortisol concentration of less than 5 μg/dL (138 mmol/L)
- concurrent measurement of corticotropin
