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What is the most common pediatric endocrine d/o?
DM type I**
What is the def of diabetes
1. Fasting glucose > 126 or... 2. 2 hr post-prandial > 200** 3. Must be 2 separate occasions
What genes are associated w/DM type I?
HLA DR3 or DR4**
What are the 3 P\\\'s associated w/DM type I?
1. Polydipsia 2. Polyuria 3. Polyphagia**
What is the long-acting insulin agent?
Lantus (glargine)
What labs do we draw for type I DM?
1. FBS 2. UA 3. Hgb A1C 4. Auto-Ab screens
What is the ONLY med for type I DM?
Insulin**
What is a typical insulin dose for first-time pt in a pre-pubertal pt that is nonketotic?
0.5U/kg/d
What is a typical insulin dose for an adolescent or in ketosis?
1.0 U/kg/d
What is the glucose/HgbA1C monitoring goal for type I diabetic < 6 y/o?
1. Glucose 110-200 2. HgbA1C --7.5-8.5%
What is the glucose/HgbA1C monitoring goal for type I diabetic that is 6-12 y/o?
1. Glucose 100-180 2. HgbA1C--<8%
What is the glucose/HgbA1C monitoring goal for a type I diabetic that is >12 y/o?
1. Glucose 90-150 2. HgbA1C--<7.5%
How often should type I diabetics check their BS?
TID** (3 x per day)
What is the most common complication of type I diabetics?
Hypoglycemia**
What are the 2 reasons for hyperglycemia in a type I diabetic?
1. Dawn phenomenon 2. Somogyi phenomenon**
What is the Dawn phenomenom?
1. Low PM insulin dose 2. Hyperglycemia @ 0200 (**physiologic GH release**) 3. Tx=increase PM insulin
What is the Somogyi phenomenom?
1. Too much insulin at night 2. Hypoglycemia @ 0200 (**due to adrenaline response**) 3. Decrease PM dose
How do we differentiate b/w Dawn phenom and Somogyi phenom?
Must get BS at 0200
What acute complication of type I diabetics has the worst prognosis?
DKA**
What are the sx of DKA?
1. Vomiting 2. Severe dehydration 3. Kussmaul respirations (Slow deep breathing) 4. Acetone breath 5. Impaired mental status 6. Abd pn
What is the first step in tx of DKA?
Fluids!**
What is the insulin dose for DKA?
0.1u/kg/hr**
What is the process to replace fluids in a DKA pt?
1. Bolus--20cc/kg (consider repeating once or twice) 2. Then 1.5 x maintenance (maintenance= 4/2/1 formula)
How do we give insulin for DKA?
1. Bolus of 0.1u/kg/hr 2. Maintenance of 0.1u/kg/hr**
What electrolyte abnormalities should we expect in DKA?
1. **Hypok+ after fluid replacement (but they present w/hyperk+)** 2. Hypophosphorous 3. Hyperchloremia
When do we begin screening kids w/type I DM for retinopathy/nephropathy?
3 yrs after dx**
How often do we do lipid profiles and TSH levels for type I diabetic?
Annually
What should we HIGHLY encourage our type 2 diabetics to do?
LOSE WEIGHT
What meds are used for type II diabetes in kids?
1. Metformin 2. TZD\\\'s
What is the def of short stature?
More than 3.5 SD below normal for age**
What is the most common etiology of short stature?
Idiopathic (66%)
What are the 2 causes for idiopathic short stature?
1. Constitutional growth delay (late bloomers) 2. Heredity (parents short)
What test can differentiate b/w constitutional growth delay and heredity as causes for short stature?
X-ray for bone age
What would an elevated BP in a person with short stature indicate?
metabolic disease
What are the classification of puberty disorders?
1. Central (brain not signalling) 2. Peripheral (ovaries/testicles not responding)**
Delayed puberty is most likely which type?
Central**
Precocious puberty is most likely which type?
Either central or peripheral**
What is the def of precocious puberty?
1. Onset > 2.5 SD before mean age for puberty (secondary sex characteristics) 2. <8 in females 3. <9 in males
What gender is 10 x more likely to have precocious puberty?
Females
What is the most common central cause of precocious puberty?
Idiopathic GnRH secretion**
McCune Albright is related to what type of puberty?
Peripheral precocious puberty
What is the def of delayed onset puberty?
1. >2.5 SD after normal age onset 2. No breast development by age 13 in girls 3. No testicular enlargement by age 14 in boys**
Most causes of delayed onset puberty are what?
lack of response from hypothalamic-pituitary-gonadal axis
What is hypogonadotropism?
No brain signal being sent (decreased GnRH/FSH/LH) **
What is hypergonadotropism?
Brain signals ARE being sent (Increased GnRH/FSH/LH) **
What are the reasons for hypogonadotropic hypogonadism?
1. GnRH secretion inhibition 2. Hypothalamus/pituitary dz
What are the causes of HYPERgonadotropic hypogonadism?
Gonadal failure (Turners/ Klinefelter\\\'s/ Androgen insensitivity/ PCOS)
Gonadal differentiation begins at what wks gestation?
9-13 wks
What gene causes male differentiation?
SRY gene on chromosome Y
What is the most likely cause of female virulization?
CAH**
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