ch. 06 endocrinology
Terms
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new-onset wt loss + polydipsia + polyphagia + polyuria
dx? - DM2
- after x% of beta-cell fxn destroyed, clinical signficance
- 90%
- when blood glucose > x, then osmotic diuresis occurs
- 180 mg/dl
- DKA sx
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1.hyperglycemia
2.metabolic acidosis
3.dehydration
4.lethargy - most common cause of DKA
- inadequate insulin dosing
- most severe complication of DKA
- cerebral edema
- most common endocrine disorder in childhood
- DM1
- DM1: main risk factor
- +FH
- hypoglycemia sx? caused by?
-
trembling, diaphoresis, flushing, tachycardia
catecholamine release -
headache + n/v + abd pain + polyuria + polydipsia + fatigue
dx? - DKA
- secondary diabetes: causes
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1.excess glucocorticoids
2.hyperthyroidism
3.pheochromocytoma
4.GH excess
5.thiazide diuretics - diabetes dx: random plasma glucose > x
- > 200 mg/dl
- in diabetic, glucose that falls to quickly can lead to...
- cerebral edema
- insulin drip: dosage
- 0.1 U/kg/hr
- diabetics develop microvascular disease after x yrs of disease
- 10 yrs
- acanthosis nigricans
-
hyperpigmentation & thickening of skin folds
usually neck back & flexor areas - only oral hypoglycemic med used in children age > 10
- metformin
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inability to concentrate urine
dx? -
diabetes insipidus
no ADH - diabetes insipidus: causes
-
1.head trauma
2.brain tumor
3.CNS infxn
4.craniophargioma removal SE -
abrupt onset polydipsia + polyuria
dx?
tx? -
diabetes insipidus
desmopressin (DDAVP) - short stature: usually due to...
-
genetics
constitutional delay - proportionate short stature: causes
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1.GH deficiency
2.primary hypothyroidism
3.Cushing disease
4.chronic systemic dz
5.psychosocial deprivation
6.Turner
7.meds - disproportionate short stature: examples
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1.achondroplasia
2.rickets - short stature: caused by what kind of meds?
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1.steroids
2.dexedrine
3.methylphenidate (ritalin) - hyperthyroidism: most common cause (& other causes)
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1.grave's disease
2."hot" nodule
3.acute suppurative thyroiditis - T/F: exophthalmos is common in hyperthyroid children
- false
- T/F: hyperthyroid childen display change in behavior & school performance
- true
-
acute-onset tachycardia + hyperthermia + fever + diaphoresis + n/v
dx? - thyroid storm
-
infant that stares + jitters + hyperactive + increased appetite + poor wt gain
dx?
tx? -
neonatal grave's
resolves over first several months - x% of children w/grave's have spontaneous remission
- 50%
- hypothyroidism: most common cause
- hashimoto's (chronic lymphocytic thyroiditis)
-
coarse puffy face + dry thin hair + dry skin + delayed DTRs + slow linear growth + delayed puberty
dx? - hypothyroid
-
hyperthyroid: tx
hypothyroid: tx -
PTU - hyperthyroid
levothyroxine - hypothyroid - congenital adrenal hyperplasia: most common cause
-
21-hydroxylase deficiency
a.classic salt-wasting
b.virilizing - 21-hydroxylase: needed to form...
-
1.cortisol
2.aldosterone - 21-hydroxylase deficiency: inheritance pattern
- autosomal recessive
- 21-hydroxylase deficiency: genital clinical presentation
-
females: ambiguous genitalia
males: nl - 21-hydroxylase deficiency: dx via...
- 17-hydroxyprogesterone levels (elevated)
- 21-hydroxylase deficiency: sx
-
1.dehydration
2.salt-wasting
3.emesis
4.shock
5.hyperkalemia, hyponatremia
6.hypoglycemia - 11-hydroxylase deficiency: sx
-
1.HTN
2.hypernatremia, hypokalemia
3.decreased renin, aldosterone - 21-hydroxylase deficiency: tx
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1.cortisol
2.mineralocorticoid - 21-hydroxylase deficiency: undertreatment may lead to...
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1.premature epiphyseal fusion
2.adult short stature - precocious puberty
- secondary sex qualities age < 7.5 (female), < 9 (boys)
- precocious puberty: causes
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girls: idiopathic
boys: CNS pathology - premature adrenarche: cause
- early maturation of adrenal androgen secretion
- gonadotropin-dependent precocious puberty: examples
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1.glioma
2.embryonic germ cell tumor
3.hamartomas - gonadotropin-independent precocious puberty: examples
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1.mccune-albright
2.leydig cell tumors
3.ectopic hCG production by hepatic/pineal tumors - GDPP: tx
- leuprolide (GnRH analogue)
- pubertal delay
- (-) 2ndary sex qualities before age 13 (females), age 14 (males)
- pubertal delay: most common cause
- constitutional delay
- Cushing syndrome: most common cause in children age > 7
- Cushing disease (bilateral adrenal hyperplasia)
- Cushing syndrome: lab studies
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1.serum cortisol
2.24-hr urine free cortisol
3.dexamethasone suppression test - prolonged dexamethasone suppression test: purpose
- differentiate adrenal tumor vs. Cushing disease
- adrenal tumor: Tx
- surgery (removal)
- addison disease
- primary adrenal insufficiency
- adrenal insufficiency: most common cause in older children & adolescence
- autoimmune
- ACTH deficiency: most common cause
- chronic steroid tx
- addisonian crisis: sx
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1.fever
2.vomiting
3.dehydration
4.shock - addisonian crisis: tx
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1.D5W
2.STRESS DOSE IV glucocorticoids - addisonian crisis: causes
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1.illness
2.surgery
3.trauma