Peds Endocrine

Question 1

Familial short stature vs. constitutional growth delay

Answer 1

FSS: normal birth weight and length, after 2 yr, linear growth velocity decelerates, then resume normal growth
CGD: Growth pattern low in linear growth velocity, but eventually catches up

Question 2

Delayed puberty

Answer 2

MC is constitutional growth delay
Girls: no pubertal signs by 13, or menarche by 16 yo.
Boys: no 2nd sex char by 14 yo

Question 3

Precocious puberty

Answer 3

pubertal development below age limit set for normal onset of puberty
Girls: onset of 2nd chr before 8 yo
Boys: 2nd char before age 9 yo

Question 4

Central diabetes insipidus

Answer 4

Eti: Genetic mutation. inability to synthesize and release vasopressin -> kidneys can’t concentrate urine -> excess urinary water loss.
S/sx: polyuria, nocturia, enuresis, intense thirst.
Dx: Serum hyperosmololity vs urine hypo-osmolarity
Tx: desmopressin

Question 5

Hypothyroidism

Answer 5

Congenital or acquired
Associated with intellectual impairment
Eti: defect in thyroid gland (primary) or hypothalamus, pituitary (central).
S/sx: sort stature, abnormal weight gain, delayed bone age, skin changes, hair loss
Dx: Primary: normal/decreased t4, elevated TSH
Central: inappropriately normal TSH, low total T4

Question 6

Hyperthyroidism

Answer 6

Eti: graves disease most common in children, antibodies directed at TSH receptors stimulate thyroid hormone production.
S/sx: poor concentration, hyperactivity, gatigue, emotional liability, insomina, weight loss.
Dx: TSH is suppressed, presence of thyroid-stimulating immunoglobulin or thyroid eye disease confirms GRAVES D.

Question 7

Thyroiditis

Answer 7

(Hashimoto)
Eti: autoimmune attack of the thyroid.
S/sx: firm, freely movable, nontender, diffusely enlarged thyroid gland
Dx; thyroid function, Needle biopsy diagnostic but seldom necessary.

Question 8

Precocious puberty

Answer 8

Eti: activation of hypothalamic GnRH pulse generator
S/sx: breast dev, pubic hair, menarche, accelerated growth
Dx: estradiol, bone age, MRI
Tx: GnRH analogues down regulate GnRH receptors

Question 9

Cryptoorchidism

Answer 9

Eti: unknown
S/sx: undescended testis
Dx: LH, FSH, inhibin B, testosterone
Ed: infertility and testicular malignancy are major risks

Question 10

Endocrine and metabolic side effects of prolonged steroid use

Answer 10

• Hypergllycemia and glycosuria
• Cushing syndrome
• Suppression of HPA axis

Question 11

Effects of prolonged steroid use on electrolytes and minerals

Answer 11

• REtention of Na and H2o
• Potassium loss
• Hypocalcemia, tetany

Question 12

Effects of prolonged steroid use on protein metabolism and skeleton

Answer 12

• Nitrogen balance
• Suppression of growth, skeletal maturation
• Muscular wasting
• Osteoporosis
• Avascular necrosis

Question 13

Type 1 DM

Answer 13

Eti: autoimmune disease
S/sx: onset often prepuberty, polyD, polyU, weight loss, fatigue, DKA
Dx: Random blood glucose >200, fasting >126, AIC > 6.5%
Tx: Insulin, diet, monitoring

Question 14

Type 2 DM

Answer 14

Eti: Genetic basis, visceral obesity, family hx.
S/sx: often onset post puberty, polyD, polyU, acanthosis nigricans, often overweight.
Pt ed: monitor other organ systems: annual eye exam

Question 15

Symptoms of DKA in kids

Answer 15

PolyU, PolyD, marked fatigue, abdominal pain, N/V, mental stupor
Rapid deep breathing with fruity breath, hyperglycemmia, ketosis, metabolic acidosis