Podcast
Questions and Answers
Why is it crucial to replace thyroid hormone in children with hypothyroidism?
Why is it crucial to replace thyroid hormone in children with hypothyroidism?
- To prevent the development of Hashimoto's thyroiditis.
- To ensure they achieve normal growth in height and cognitive function. (correct)
- To decrease TSH level.
- To avoid prolonged bilirubin elevation in older children.
A newborn screening reveals an elevated TSH level. What is the most appropriate next step in evaluating the newborn for hypothyroidism?
A newborn screening reveals an elevated TSH level. What is the most appropriate next step in evaluating the newborn for hypothyroidism?
- Immediately start the baby on thyroxine replacement therapy.
- Consult with a pediatric endocrinologist for a thyroidectomy.
- Perform a T3 uptake test to determine the severity of hypothyroidism.
- Repeat the TSH test and add a free T4 test. (correct)
Which of the following is the most common cause of juvenile acquired hypothyroidism?
Which of the following is the most common cause of juvenile acquired hypothyroidism?
- Iodine deficiency.
- Pituitary deficiency of growth hormone.
- Congenital absence of the thyroid gland.
- Hashimoto’s thyroiditis. (correct)
An 8-year-old child presents with weakness, cold intolerance, constipation, and poor growth. Initial labs reveal an elevated TSH and decreased free T4. Which of the following conditions is most likely?
An 8-year-old child presents with weakness, cold intolerance, constipation, and poor growth. Initial labs reveal an elevated TSH and decreased free T4. Which of the following conditions is most likely?
Which of the following is a potential cause of congenital hypothyroidism that directly affects the fetus during the first trimester?
Which of the following is a potential cause of congenital hypothyroidism that directly affects the fetus during the first trimester?
A child presents with decreased T3, increased serum cholesterol, and hyponatremia. These findings are MOST indicative of which condition?
A child presents with decreased T3, increased serum cholesterol, and hyponatremia. These findings are MOST indicative of which condition?
What is the recommended starting dosage of L-thyroxine for a 5-year-old child diagnosed with hypothyroidism?
What is the recommended starting dosage of L-thyroxine for a 5-year-old child diagnosed with hypothyroidism?
Which of the following is classified as a primary growth disorder?
Which of the following is classified as a primary growth disorder?
Which diagnostic test is MOST appropriate to rule out Turner syndrome in a female child presenting with short stature?
Which diagnostic test is MOST appropriate to rule out Turner syndrome in a female child presenting with short stature?
A child's height is below the 3rd percentile. Which of the following additional findings would be MOST concerning for a growth disorder?
A child's height is below the 3rd percentile. Which of the following additional findings would be MOST concerning for a growth disorder?
A child presents with a dark, velvety line around their neck (acanthosis nigricans). This finding is MOST indicative of which underlying condition?
A child presents with a dark, velvety line around their neck (acanthosis nigricans). This finding is MOST indicative of which underlying condition?
Which characteristic is associated with proportionate short stature?
Which characteristic is associated with proportionate short stature?
During a physical exam for growth assessment, which measurement technique is MOST appropriate for a child younger than 2 years old?
During a physical exam for growth assessment, which measurement technique is MOST appropriate for a child younger than 2 years old?
When evaluating a child for potential endocrine dysfunction, which historical factor is MOST important to consider regarding maternal health during pregnancy?
When evaluating a child for potential endocrine dysfunction, which historical factor is MOST important to consider regarding maternal health during pregnancy?
A child with short stature is suspected of having a secondary growth disorder. Which lab test would be MOST useful in evaluating a potential underlying cause?
A child with short stature is suspected of having a secondary growth disorder. Which lab test would be MOST useful in evaluating a potential underlying cause?
A child is diagnosed with Rickets, a form of disproportionate short stature. What is the underlying cause of Rickets?
A child is diagnosed with Rickets, a form of disproportionate short stature. What is the underlying cause of Rickets?
A child's bone age is typically assessed using an X-ray of which body part?
A child's bone age is typically assessed using an X-ray of which body part?
Which of the following is the MOST direct role of thyroid cells in the production of thyroid hormones?
Which of the following is the MOST direct role of thyroid cells in the production of thyroid hormones?
A child exhibiting recurrent vomiting and unexplained lethargy may warrant investigation for which of the following?
A child exhibiting recurrent vomiting and unexplained lethargy may warrant investigation for which of the following?
After performing a physical exam on a pediatric patient, you note the presence of striae. This clinical finding MOST likely indicates:
After performing a physical exam on a pediatric patient, you note the presence of striae. This clinical finding MOST likely indicates:
A newborn is diagnosed with congenital hypothyroidism. The MOST significant risk associated with untreated congenital hypothyroidism is:
A newborn is diagnosed with congenital hypothyroidism. The MOST significant risk associated with untreated congenital hypothyroidism is:
A child presents with height below the 3rd percentile, normal birth length and weight, and delayed puberty. What is the MOST likely condition, assuming no chronic illness is present?
A child presents with height below the 3rd percentile, normal birth length and weight, and delayed puberty. What is the MOST likely condition, assuming no chronic illness is present?
What key historical finding differentiates Constitutional Growth Delay (CGD) from other growth disorders?
What key historical finding differentiates Constitutional Growth Delay (CGD) from other growth disorders?
Why is an endocrinologist referral important for a child suspected of having Constitutional Growth Delay (CGD)?
Why is an endocrinologist referral important for a child suspected of having Constitutional Growth Delay (CGD)?
What is the definition of true precocious puberty?
What is the definition of true precocious puberty?
When should delayed puberty be considered in boys and girls, respectively?
When should delayed puberty be considered in boys and girls, respectively?
A 13-year-old girl presents with breast budding. According to the guidelines presented, within what timeframe should she typically progress to menarche?
A 13-year-old girl presents with breast budding. According to the guidelines presented, within what timeframe should she typically progress to menarche?
Which of the following is a characteristic feature of Type 1 Diabetes Mellitus?
Which of the following is a characteristic feature of Type 1 Diabetes Mellitus?
What are the classic signs and symptoms of Type 1 Diabetes Mellitus?
What are the classic signs and symptoms of Type 1 Diabetes Mellitus?
Which of the following signs and symptoms is LEAST likely to be associated with a new diagnosis of Type 1 Diabetes Mellitus in a youth?
Which of the following signs and symptoms is LEAST likely to be associated with a new diagnosis of Type 1 Diabetes Mellitus in a youth?
A 12-year-old is newly diagnosed with Type 1 Diabetes. What is the PRIMARY initial goal for their Hemoglobin A1c (HgbA1c) level, according to current guidelines?
A 12-year-old is newly diagnosed with Type 1 Diabetes. What is the PRIMARY initial goal for their Hemoglobin A1c (HgbA1c) level, according to current guidelines?
Which of the following laboratory findings is MOST indicative of Type 1 Diabetes Mellitus?
Which of the following laboratory findings is MOST indicative of Type 1 Diabetes Mellitus?
A 15-year-old obese patient is diagnosed with Type 2 Diabetes. Besides lifestyle modifications, what is the recommended first-line pharmacotherapy?
A 15-year-old obese patient is diagnosed with Type 2 Diabetes. Besides lifestyle modifications, what is the recommended first-line pharmacotherapy?
Which of the following characteristics is MORE commonly associated with Type 2 Diabetes compared to Type 1 Diabetes in youth?
Which of the following characteristics is MORE commonly associated with Type 2 Diabetes compared to Type 1 Diabetes in youth?
A child with Type 1 Diabetes experiences a hypoglycemic episode. Besides administering a fast-acting carbohydrate, what is an important next step?
A child with Type 1 Diabetes experiences a hypoglycemic episode. Besides administering a fast-acting carbohydrate, what is an important next step?
Which of the following complications is MOST closely associated with Type 2 Diabetes in adolescent females?
Which of the following complications is MOST closely associated with Type 2 Diabetes in adolescent females?
A 10-year-old child is suspected of having diabetes. Which fasting blood sugar level would require a repeat test on another day to confirm a diagnosis of diabetes?
A 10-year-old child is suspected of having diabetes. Which fasting blood sugar level would require a repeat test on another day to confirm a diagnosis of diabetes?
What frequency of Hemoglobin A1c measurement is generally recommended for children with stable type 2 diabetes who are meeting their glycemic goals?
What frequency of Hemoglobin A1c measurement is generally recommended for children with stable type 2 diabetes who are meeting their glycemic goals?
Which of the following lipid panel results would be considered within the target range for a child with type 2 diabetes?
Which of the following lipid panel results would be considered within the target range for a child with type 2 diabetes?
A 6-year-old child with hypothyroidism is prescribed L-thyroxine. Based on the provided guidelines, what would be the MOST appropriate dosage range?
A 6-year-old child with hypothyroidism is prescribed L-thyroxine. Based on the provided guidelines, what would be the MOST appropriate dosage range?
Which of the following lab results would be LEAST likely in a child with untreated hypothyroidism?
Which of the following lab results would be LEAST likely in a child with untreated hypothyroidism?
A child's growth chart shows a pattern of slow growth for the first few years, followed by a low-normal growth velocity. Bone age is consistent with height age. Which condition is MOST likely?
A child's growth chart shows a pattern of slow growth for the first few years, followed by a low-normal growth velocity. Bone age is consistent with height age. Which condition is MOST likely?
An infant is suspected of having congenital hypothyroidism. Which combination of signs and symptoms would be MOST indicative of this condition?
An infant is suspected of having congenital hypothyroidism. Which combination of signs and symptoms would be MOST indicative of this condition?
When evaluating a child with short stature, which of the following clinical findings would be MOST suggestive of Turner syndrome?
When evaluating a child with short stature, which of the following clinical findings would be MOST suggestive of Turner syndrome?
A 10-year-old patient presents with fatigue, constipation, and declining academic performance. Lab results show an elevated TSH. What is the MOST likely underlying cause, assuming no other significant medical history?
A 10-year-old patient presents with fatigue, constipation, and declining academic performance. Lab results show an elevated TSH. What is the MOST likely underlying cause, assuming no other significant medical history?
A child presents with disproportionate short stature. Which of the following underlying conditions is MOST likely if the child also exhibits bow legs, weakness, and bone pain?
A child presents with disproportionate short stature. Which of the following underlying conditions is MOST likely if the child also exhibits bow legs, weakness, and bone pain?
A newborn screening indicates an elevated TSH level. After confirming this result with a repeat test and a low free T4, what is the MOST important immediate intervention?
A newborn screening indicates an elevated TSH level. After confirming this result with a repeat test and a low free T4, what is the MOST important immediate intervention?
A child's height is below the 3rd percentile. What annual growth rate would warrant further investigation for a growth disorder?
A child's height is below the 3rd percentile. What annual growth rate would warrant further investigation for a growth disorder?
A child is diagnosed with hypothyroidism due to inherent dysfunction in the assimilation of iodine. At which point did this dysfunction MOST likely begin to affect the child's thyroid development?
A child is diagnosed with hypothyroidism due to inherent dysfunction in the assimilation of iodine. At which point did this dysfunction MOST likely begin to affect the child's thyroid development?
A teenage patient exhibits signs of hypothyroidism and reports consuming a diet deficient in iodine over several years. How does iodine deficiency impact the thyroid's ability to synthesize hormones?
A teenage patient exhibits signs of hypothyroidism and reports consuming a diet deficient in iodine over several years. How does iodine deficiency impact the thyroid's ability to synthesize hormones?
Which of the following features is MOST characteristic of proportionate short stature?
Which of the following features is MOST characteristic of proportionate short stature?
Which of the following would be LEAST helpful in differentiating between primary and secondary growth disorders?
Which of the following would be LEAST helpful in differentiating between primary and secondary growth disorders?
When assessing a child for growth abnormalities, why is it important to compare sitting and standing heights?
When assessing a child for growth abnormalities, why is it important to compare sitting and standing heights?
During the physical exam of a child being evaluated for a potential endocrine disorder, what does the presence of acanthosis nigricans MOST likely indicate?
During the physical exam of a child being evaluated for a potential endocrine disorder, what does the presence of acanthosis nigricans MOST likely indicate?
When evaluating a child for a potential endocrine disorder, which aspect of the child's history is MOST important to gather?
When evaluating a child for a potential endocrine disorder, which aspect of the child's history is MOST important to gather?
Why is bone age assessment, typically via X-ray of the left wrist, important in the evaluation of endocrine disorders affecting growth?
Why is bone age assessment, typically via X-ray of the left wrist, important in the evaluation of endocrine disorders affecting growth?
A child presents with recurrent vomiting and unexplained lethargy. Which of the following endocrine or metabolic conditions should be HIGHLY considered?
A child presents with recurrent vomiting and unexplained lethargy. Which of the following endocrine or metabolic conditions should be HIGHLY considered?
What is the underlying mechanism by which thyroid cells produce T3 and T4 hormones?
What is the underlying mechanism by which thyroid cells produce T3 and T4 hormones?
Following a physical exam, you observe striae on an adolescent patient. What condition does this clinical finding MOST likely suggest?
Following a physical exam, you observe striae on an adolescent patient. What condition does this clinical finding MOST likely suggest?
When evaluating a child with growth concerns, which diagnostic procedure would be MOST appropriate for assessing thyroid gland symmetry and size?
When evaluating a child with growth concerns, which diagnostic procedure would be MOST appropriate for assessing thyroid gland symmetry and size?
A 10-year-old boy is significantly shorter than his peers. His parents report a family history of late bloomers. Physical exam is normal. Which of the following findings would MOST strongly suggest Constitutional Growth Delay (CGD)?
A 10-year-old boy is significantly shorter than his peers. His parents report a family history of late bloomers. Physical exam is normal. Which of the following findings would MOST strongly suggest Constitutional Growth Delay (CGD)?
A child with Constitutional Growth Delay (CGD) is likely to exhibit which of the following growth patterns?
A child with Constitutional Growth Delay (CGD) is likely to exhibit which of the following growth patterns?
What is the PRIMARY reason an endocrinologist referral is recommended for a child suspected of Constitutional Growth Delay (CGD)?
What is the PRIMARY reason an endocrinologist referral is recommended for a child suspected of Constitutional Growth Delay (CGD)?
A 9-year-old girl presents with breast budding and pubic hair development. This is considered precocious puberty. Which statement accurately describes precocious puberty?
A 9-year-old girl presents with breast budding and pubic hair development. This is considered precocious puberty. Which statement accurately describes precocious puberty?
At what age should delayed puberty be considered in boys and girls, respectively, if they show no clinical features of puberty?
At what age should delayed puberty be considered in boys and girls, respectively, if they show no clinical features of puberty?
A 16-year-old boy shows no signs of testicular enlargement or pubic hair development. What is the MOST appropriate next step?
A 16-year-old boy shows no signs of testicular enlargement or pubic hair development. What is the MOST appropriate next step?
A 7-year-old presents with polyuria, polydipsia, and weight loss. Which underlying physiological process is the MOST likely cause of these symptoms in Type 1 Diabetes Mellitus?
A 7-year-old presents with polyuria, polydipsia, and weight loss. Which underlying physiological process is the MOST likely cause of these symptoms in Type 1 Diabetes Mellitus?
Which genetic factor is STRONGLY associated with an increased risk of developing Type 1 Diabetes Mellitus?
Which genetic factor is STRONGLY associated with an increased risk of developing Type 1 Diabetes Mellitus?
A 14-year-old patient with Type 2 Diabetes presents with a Hemoglobin A1c of 8.2% despite consistent lifestyle modifications for the past 4 months. According to the guidelines, what is the MOST appropriate next step in management?
A 14-year-old patient with Type 2 Diabetes presents with a Hemoglobin A1c of 8.2% despite consistent lifestyle modifications for the past 4 months. According to the guidelines, what is the MOST appropriate next step in management?
What distinguishes Type 1 Diabetes Mellitus from Type 2 Diabetes Mellitus in youth regarding insulin sensitivity?
What distinguishes Type 1 Diabetes Mellitus from Type 2 Diabetes Mellitus in youth regarding insulin sensitivity?
A 9-year-old presents with polyuria, polydipsia, and significant weight loss despite increased appetite. A random blood sugar is 240 mg/dL. What is the MOST appropriate next step?
A 9-year-old presents with polyuria, polydipsia, and significant weight loss despite increased appetite. A random blood sugar is 240 mg/dL. What is the MOST appropriate next step?
A 16-year-old female with Type 2 Diabetes has a lipid panel showing LDL 110 mg/dL, HDL 35 mg/dL, and triglycerides 160 mg/dL. Which of the following is the MOST appropriate intervention based on these results?
A 16-year-old female with Type 2 Diabetes has a lipid panel showing LDL 110 mg/dL, HDL 35 mg/dL, and triglycerides 160 mg/dL. Which of the following is the MOST appropriate intervention based on these results?
In a youth with Type 1 Diabetes, which of the following BEST describes the relationship between carbohydrate intake and insulin dosage?
In a youth with Type 1 Diabetes, which of the following BEST describes the relationship between carbohydrate intake and insulin dosage?
Why is annual urine testing for microalbumin recommended for children and adolescents with diabetes?
Why is annual urine testing for microalbumin recommended for children and adolescents with diabetes?
What percentage of youth with Type 2 Diabetes have a first-degree relative with the disease?
What percentage of youth with Type 2 Diabetes have a first-degree relative with the disease?
What is the recommended frequency of Hemoglobin A1c measurement for children with stable Type 2 Diabetes who are meeting their glycemic goals?
What is the recommended frequency of Hemoglobin A1c measurement for children with stable Type 2 Diabetes who are meeting their glycemic goals?
A 13-year-old male with Type 1 Diabetes is consistently missing his evening insulin dose. What is the MOST appropriate initial intervention?
A 13-year-old male with Type 1 Diabetes is consistently missing his evening insulin dose. What is the MOST appropriate initial intervention?
What distinguishes the typical onset of Type 1 Diabetes from Type 2 Diabetes in adolescents?
What distinguishes the typical onset of Type 1 Diabetes from Type 2 Diabetes in adolescents?
A 6-month-old infant presents with lethargy, poor feeding, and prolonged jaundice. Which of the following sets of lab results would be most consistent with congenital hypothyroidism?
A 6-month-old infant presents with lethargy, poor feeding, and prolonged jaundice. Which of the following sets of lab results would be most consistent with congenital hypothyroidism?
An 11-year-old child presents with fatigue, constipation, and cold intolerance. Initial labs show an elevated TSH. What is the MOST likely cause of this child's hypothyroidism?
An 11-year-old child presents with fatigue, constipation, and cold intolerance. Initial labs show an elevated TSH. What is the MOST likely cause of this child's hypothyroidism?
Which of the following mechanisms is MOST likely to cause congenital hypothyroidism?
Which of the following mechanisms is MOST likely to cause congenital hypothyroidism?
Why is prompt diagnosis and treatment of congenital hypothyroidism crucial in neonates?
Why is prompt diagnosis and treatment of congenital hypothyroidism crucial in neonates?
A newborn screening reveals an elevated TSH. After the test is repeated and remains high, what further diagnostic step is essential in confirming the presence and cause of Congenital Hypothyroidism.
A newborn screening reveals an elevated TSH. After the test is repeated and remains high, what further diagnostic step is essential in confirming the presence and cause of Congenital Hypothyroidism.
A child presents with growth deceleration. Which aspect of their history would be MOST relevant in determining potential endocrine involvement?
A child presents with growth deceleration. Which aspect of their history would be MOST relevant in determining potential endocrine involvement?
During a physical examination for growth assessment, what is the MOST appropriate method for measuring the stature of a 15-month-old child?
During a physical examination for growth assessment, what is the MOST appropriate method for measuring the stature of a 15-month-old child?
Which clinical finding on a child's skin would warrant further investigation for an endocrine or metabolic disorder?
Which clinical finding on a child's skin would warrant further investigation for an endocrine or metabolic disorder?
During the physical exam of a child being evaluated for a potential endocrine disorder, what is the purpose of palpating the neck?
During the physical exam of a child being evaluated for a potential endocrine disorder, what is the purpose of palpating the neck?
Which of the following statements BEST describes the role of tyrosine in thyroid hormone synthesis?
Which of the following statements BEST describes the role of tyrosine in thyroid hormone synthesis?
To assess bone age in a child with suspected endocrine dysfunction affecting growth, which radiographic study is MOST commonly used?
To assess bone age in a child with suspected endocrine dysfunction affecting growth, which radiographic study is MOST commonly used?
A child’s growth chart reveals a pattern of declining height percentile over the past year. What additional information from the child’s history would be MOST concerning for an endocrine disorder?
A child’s growth chart reveals a pattern of declining height percentile over the past year. What additional information from the child’s history would be MOST concerning for an endocrine disorder?
A newborn screening identifies a potential case of congenital hypothyroidism. Why is prompt diagnosis and treatment essential?
A newborn screening identifies a potential case of congenital hypothyroidism. Why is prompt diagnosis and treatment essential?
A 4-year-old child is diagnosed with hypothyroidism. Which of the following L-thyroxine dosages aligns with the recommended guidelines?
A 4-year-old child is diagnosed with hypothyroidism. Which of the following L-thyroxine dosages aligns with the recommended guidelines?
An 11-year-old is diagnosed with hypothyroidism. Besides referral to a pediatric endocrinologist, what other lab value might be elevated?
An 11-year-old is diagnosed with hypothyroidism. Besides referral to a pediatric endocrinologist, what other lab value might be elevated?
A child with short stature is suspected of having Turner syndrome. Which diagnostic test is MOST appropriate to confirm this suspicion?
A child with short stature is suspected of having Turner syndrome. Which diagnostic test is MOST appropriate to confirm this suspicion?
A child presents with proportionate short stature. Which of the following historical findings increases suspicion for Intrauterine Growth Retardation (IUGR)?
A child presents with proportionate short stature. Which of the following historical findings increases suspicion for Intrauterine Growth Retardation (IUGR)?
A child's height is below the 3rd percentile. What ANNUAL growth rate is MOST concerning for a growth disorder and warrants further investigation?
A child's height is below the 3rd percentile. What ANNUAL growth rate is MOST concerning for a growth disorder and warrants further investigation?
What finding is MOST indicative of proportionate short stature?
What finding is MOST indicative of proportionate short stature?
A child is diagnosed with Rickets, a form of disproportionate short stature. What physical examination finding would support this diagnosis?
A child is diagnosed with Rickets, a form of disproportionate short stature. What physical examination finding would support this diagnosis?
Which one of the following disorders is considered a primary growth disorder?
Which one of the following disorders is considered a primary growth disorder?
A child presents with short stature, normal birth weight and length, and delayed puberty. Which additional finding would MOST suggest Constitutional Growth Delay (CGD)?
A child presents with short stature, normal birth weight and length, and delayed puberty. Which additional finding would MOST suggest Constitutional Growth Delay (CGD)?
A 14-year-old male shows no signs of pubertal development during a routine physical exam. What is the MOST appropriate next step?
A 14-year-old male shows no signs of pubertal development during a routine physical exam. What is the MOST appropriate next step?
A 9-year-old girl presents with breast budding and the development of pubic hair. This is determined to be precocious puberty. Which statement accurately describes precocious puberty?
A 9-year-old girl presents with breast budding and the development of pubic hair. This is determined to be precocious puberty. Which statement accurately describes precocious puberty?
Which of the following is the MOST likely underlying cause of polyuria, polydipsia, and polyphagia in a child newly diagnosed with Type 1 Diabetes Mellitus?
Which of the following is the MOST likely underlying cause of polyuria, polydipsia, and polyphagia in a child newly diagnosed with Type 1 Diabetes Mellitus?
A child is suspected of having Constitutional Growth Delay (CGD). What finding would be LEAST consistent with this diagnosis?
A child is suspected of having Constitutional Growth Delay (CGD). What finding would be LEAST consistent with this diagnosis?
Family history is an important factor in diagnosing Constitutional Growth Delay. Short stature and delayed puberty in which family members are MOST relevant?
Family history is an important factor in diagnosing Constitutional Growth Delay. Short stature and delayed puberty in which family members are MOST relevant?
Which of the following BEST describes the underlying cause of Type 1 Diabetes Mellitus?
Which of the following BEST describes the underlying cause of Type 1 Diabetes Mellitus?
What is the PRIMARY reason to refer a child suspected of having Constitutional Growth Delay (CGD) to an endocrinologist?
What is the PRIMARY reason to refer a child suspected of having Constitutional Growth Delay (CGD) to an endocrinologist?
A 13-year-old patient with Type 1 Diabetes Mellitus presents to the clinic. Which physical exam finding is LEAST likely to be associated with this condition?
A 13-year-old patient with Type 1 Diabetes Mellitus presents to the clinic. Which physical exam finding is LEAST likely to be associated with this condition?
Which of the following lab results is MOST indicative of Type 1 Diabetes Mellitus rather than Type 2 Diabetes Mellitus in a newly diagnosed 10-year-old?
Which of the following lab results is MOST indicative of Type 1 Diabetes Mellitus rather than Type 2 Diabetes Mellitus in a newly diagnosed 10-year-old?
What is the MOST critical difference in the goal for HbA1c between children with Type 1 Diabetes and adults with Type 1 Diabetes?
What is the MOST critical difference in the goal for HbA1c between children with Type 1 Diabetes and adults with Type 1 Diabetes?
A 14-year-old obese patient is diagnosed with Type 2 Diabetes and has a Hemoglobin A1c of 8.5%. After 3 months of lifestyle modifications, the HgbA1c remains at 8.3%. What is the MOST appropriate next step in management?
A 14-year-old obese patient is diagnosed with Type 2 Diabetes and has a Hemoglobin A1c of 8.5%. After 3 months of lifestyle modifications, the HgbA1c remains at 8.3%. What is the MOST appropriate next step in management?
Which of the following lipid panel results would suggest the MOST need for intervention in a 12-year-old with Type 2 Diabetes?
Which of the following lipid panel results would suggest the MOST need for intervention in a 12-year-old with Type 2 Diabetes?
A 15-year-old female with Type 2 Diabetes is found to have polycystic ovary syndrome (PCOS). What is the MOST significant long-term health risk associated with PCOS in adolescent females with diabetes?
A 15-year-old female with Type 2 Diabetes is found to have polycystic ovary syndrome (PCOS). What is the MOST significant long-term health risk associated with PCOS in adolescent females with diabetes?
A 12-year-old patient with Type 1 Diabetes reports frequent episodes of nocturnal enuresis. Which of the following is the MOST likely contributing factor in this patient?
A 12-year-old patient with Type 1 Diabetes reports frequent episodes of nocturnal enuresis. Which of the following is the MOST likely contributing factor in this patient?
Which of the following statements BEST highlights a key difference in the typical onset of Type 1 versus Type 2 Diabetes in adolescents?
Which of the following statements BEST highlights a key difference in the typical onset of Type 1 versus Type 2 Diabetes in adolescents?
A 13-year-old male with Type 1 Diabetes is started on an insulin regimen that involves carb counting. How does carbohydrate intake PRIMARILY influence insulin dosage in this regimen?
A 13-year-old male with Type 1 Diabetes is started on an insulin regimen that involves carb counting. How does carbohydrate intake PRIMARILY influence insulin dosage in this regimen?
A 10-year-old child is suspected of having diabetes. A fasting blood sugar comes back at 120 mg/dL. What is the MOST appropriate next step?
A 10-year-old child is suspected of having diabetes. A fasting blood sugar comes back at 120 mg/dL. What is the MOST appropriate next step?
Flashcards
Hypothyroidism Definition
Hypothyroidism Definition
A condition with a deficiency in circulating thyroid hormone.
Congenital Hypothyroidism
Congenital Hypothyroidism
Present at birth, may stem from issues like thyroid gland absence or iodine assimilation problems.
Juvenile Acquired Hypothyroidism
Juvenile Acquired Hypothyroidism
Develops later in life, potentially caused by Hashimoto's thyroiditis or iodine deficiency.
Infant Hypothyroidism Symptoms
Infant Hypothyroidism Symptoms
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Older Child Hypothyroidism Symptoms
Older Child Hypothyroidism Symptoms
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Growth History Key Factors
Growth History Key Factors
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Physical Exam Key Elements
Physical Exam Key Elements
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Acanthosis Nigricans
Acanthosis Nigricans
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Bone Age Assessment
Bone Age Assessment
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Endocrine/Metabolic Labs & Diagnostics
Endocrine/Metabolic Labs & Diagnostics
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T4 (Thyroxine) & T3 (Triiodothyronine)
T4 (Thyroxine) & T3 (Triiodothyronine)
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Iodine Absorption
Iodine Absorption
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Low Thyroxine Consequence
Low Thyroxine Consequence
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Decreased T3
Decreased T3
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Increased Serum Cholesterol and Liver Enzymes
Increased Serum Cholesterol and Liver Enzymes
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Pediatric Endocrinologist
Pediatric Endocrinologist
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L-thyroxine
L-thyroxine
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Growth Disorders
Growth Disorders
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Proportional Short Stature
Proportional Short Stature
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Disproportionate Short Stature
Disproportionate Short Stature
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Short Stature Definition
Short Stature Definition
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Constitutional Growth Delay (CGD)
Constitutional Growth Delay (CGD)
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Signs of Constitutional Growth Delay
Signs of Constitutional Growth Delay
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Precocious Puberty
Precocious Puberty
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Delayed Puberty
Delayed Puberty
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Girls and Puberty progression
Girls and Puberty progression
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Boys and Puberty progression
Boys and Puberty progression
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Diabetes Mellitus
Diabetes Mellitus
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Type 1 Diabetes
Type 1 Diabetes
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Type 1 Diabetes Symptoms
Type 1 Diabetes Symptoms
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Diabetic Neuropathy
Diabetic Neuropathy
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Diabetic Ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA)
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Fasting Blood Sugar (Diagnostic)
Fasting Blood Sugar (Diagnostic)
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Target HgbA1C (Youth with Type 1)
Target HgbA1C (Youth with Type 1)
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Carb Counting
Carb Counting
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Type 2 Diabetes (Race/Ethnicity)
Type 2 Diabetes (Race/Ethnicity)
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PCOS (in Type 2 Diabetes)
PCOS (in Type 2 Diabetes)
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HgbA1C goal (Type 2)
HgbA1C goal (Type 2)
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Initial Type 2 DM Treatment
Initial Type 2 DM Treatment
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Congenital causes of Hypothyroidism
Congenital causes of Hypothyroidism
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Juvenile acquired Hypothyroidism causes
Juvenile acquired Hypothyroidism causes
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High TSH Level
High TSH Level
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Low T4 Level
Low T4 Level
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Stature Measurement
Stature Measurement
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Height Age
Height Age
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Tanner Staging
Tanner Staging
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Skin & Neck Exam
Skin & Neck Exam
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Thyroid Gland Palpation
Thyroid Gland Palpation
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Bone Age Test
Bone Age Test
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Serum and Urine Studies
Serum and Urine Studies
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Thyroid Cells Function
Thyroid Cells Function
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Growth Delay
Growth Delay
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True Precocious Puberty
True Precocious Puberty
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L-Thyroxine (Synthroid)
L-Thyroxine (Synthroid)
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Primary vs. Secondary Growth Disorders
Primary vs. Secondary Growth Disorders
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Primary Growth Disorders
Primary Growth Disorders
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Polyuria
Polyuria
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Secondary Growth Disorders
Secondary Growth Disorders
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Initial Growth Disorder Labs
Initial Growth Disorder Labs
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Polydipsia
Polydipsia
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Hormonal Growth Labs
Hormonal Growth Labs
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Type 1 Diabetes Symptoms (Youth)
Type 1 Diabetes Symptoms (Youth)
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Severe Type 1 Diabetes Signs
Severe Type 1 Diabetes Signs
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Diabetes Diagnostic Criterion (Fasting)
Diabetes Diagnostic Criterion (Fasting)
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Diabetes Diagnostic Criterion (Random)
Diabetes Diagnostic Criterion (Random)
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Target HgbA1C (Youth)
Target HgbA1C (Youth)
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Type 2 Diabetes (Youth)
Type 2 Diabetes (Youth)
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Insulin Dynamics (Type 2)
Insulin Dynamics (Type 2)
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Lipid Goals (Type 2 Youth)
Lipid Goals (Type 2 Youth)
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Kidney Monitoring (Diabetes)
Kidney Monitoring (Diabetes)
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Newborn Screening
Newborn Screening
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Hypothyroidism Treatment Goal
Hypothyroidism Treatment Goal
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Elevated TSH Implies...
Elevated TSH Implies...
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Congenital Hypothyroidism: Central Cause
Congenital Hypothyroidism: Central Cause
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Free T4 in Hypothyroidism
Free T4 in Hypothyroidism
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Growth History Questions
Growth History Questions
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Key History Factors
Key History Factors
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Physical Exam Focus
Physical Exam Focus
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Endocrine Diagnostic Tools
Endocrine Diagnostic Tools
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Bone Age Determination
Bone Age Determination
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Thyroid Hormone Function
Thyroid Hormone Function
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Iodine Absorption Location
Iodine Absorption Location
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Low Thyroxine Outcome
Low Thyroxine Outcome
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Hyponatremia
Hyponatremia
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Hypoglycemia
Hypoglycemia
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Anemia
Anemia
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Growth Disorders Classifications
Growth Disorders Classifications
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Constitutional Delay
Constitutional Delay
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Disproportionate Stature
Disproportionate Stature
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Rickets
Rickets
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Constitutional Growth Delay
Constitutional Growth Delay
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Polyphagia
Polyphagia
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Classic T1DM Symptoms
Classic T1DM Symptoms
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Severe T1DM Signs
Severe T1DM Signs
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Type 1 Diabetes Cause
Type 1 Diabetes Cause
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Fasting Blood Sugar (Diabetes)
Fasting Blood Sugar (Diabetes)
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Random Blood Sugar (Diabetes)
Random Blood Sugar (Diabetes)
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Target HgbA1C (Youth with T1DM)
Target HgbA1C (Youth with T1DM)
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Carb Counting (Diabetes)
Carb Counting (Diabetes)
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Type 2 Diabetes in Youth
Type 2 Diabetes in Youth
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Study Notes
The History
- Key questions to ask include the child’s growth pattern, any recent changes (weight, height), and medications affecting endocrine or metabolic function.
- Inquire about signs or symptoms of endocrine/metabolic dysfunction and maternal exposure to certain substances during pregnancy.
- It's important to note the child's diet and exercise history and any family history of endocrine or autoimmune disorders.
- Other key indicators are unusual odors, recurrent vomiting, or unexplained lethargy.
The Physical Exam
- Stature measurement differs by age, supine for kids <2 yrs, standing for kids >2 yrs.
- Check for proportionate appearance via sitting/standing heights.
- Height age, genitalia, and stage of sexual development (Tanner staging) should be assessed.
- Document facial, axillary, and pubic hair.
- Skin and neck examination might reveal acanthosis nigricans (hyperglycemia/PCOS) or striae (extended growth/obesity).
- Palpate the neck to assess thyroid gland symmetry/size for thyroid development issues.
- Check for dysmorphic features, and complete a general neurological exam.
- Palpate the abdomen to check for organomegaly.
Labs/ Diagnostics for Endocrine and Metabolic Disorders
- Genetic testing assists in identifying metabolic and endocrine dysfunctions.
- Hormone level measurements are a key tool.
- Blood and urine profiles can show glucose, galactose, and amino acid levels for diagnosis of diabetes and other metabolic problems.
- Radiographic and imaging studies, including bone age X-rays determine where they should be compared to what is normal for their age.
- Ultrasound, CT scans, and MRIs can also assist in diagnosis.
Understanding Low Thyroid Function
- Iodine is taken in many foods, and the body turns it into thyroxine (T4) and triiodothyronine (T3).
- Thyroid cells are the only ones capable of absorbing iodine, combining it with the amino acid tyrosine to make T3 and T4.
- Low thyroxine levels result in growth and development concerns, particularly in younger children.
- Congenital hypothyroidism is present in 1 in 200-1/3000 births, impacting developmental potential.
- 10-20% of cases are inherited, and 4.6% of US children 12+ have hypothyroidism.
Hypothyroidism
- Insufficient circulating thyroid hormone characterizes the condition.
- Congenital hypothyroidism develops while in utero or via absence/underdevelopment of thyroid gland.
- It can also stem from inherent dysfunction in iodine transport/assimilation or hypothalamic/pituitary disorders.
- Juvenile acquired hypothyroidism may result from Hashimoto's thyroiditis, pituitary deficiency of TSH, iodine deficiency, or thyroid gland damage.
Hypothyroidism Signs and Symptoms
- Neonates/infants may show lethargy, poor feeding, prolonged bilirubin elevation, growth deceleration, large fontanels, bradycardia, and hypotonia.
- Older children's symptoms include weakness, muscle fatigue, arthralgia, cramps, cold intolerance, constipation, weight gain, mental/physical sluggishness, delayed bone age, poor growth, puffy eyes, and a thick tongue.
Labs/Diagnostic Tests for Hypothyroidism
- Newborn screening is mandatory.
- If Free T4 (not bound) is decreased, it is a significant indicator for hypothyroidism.
- High TSH mandates a repeat test with added free T4 to reevaluate thyroid function.
- T3 may sometimes register as low.
- Other indicators are increased serum cholesterol and liver enzymes, hyponatremia, hypoglycemia, and anemia.
Hypothyroidism Management
- Early referral to a pediatric endocrinologist is advised.
- Treatment involves L-thyroxine (Synthroid) hormone replacement, with dosage varying based on age: 4-6 mcg/kg/day (1-3 yr), 3-5 mcg/kg/day (3-10 yr), 2-4 mcg/kg/day (10-16 yr), and 1.6 mcg/kg/day (>17 yr).
- Thyroid function tests (TFT) include TSH, T4, and T3 level analysis
Growth Disorders
- Growth disorders are classified as primary or secondary, a common pediatric problem.
- Primary growth disorders: skeletal dysplasia, chromosomal abnormalities, and genetic short stature.
- Secondary (due to another cause): undernutrition, from chronic disease, endocrine disorder, or idiopathic (constitutional) growth delay.
Labs/ Diagnostics for Growth Disorders
- Tests include CBC, ESR, urinalysis, celiac/IBD screening, a chemistry pane, growth factor, a bone x-ray, and thyroid function test.
- Karyotype testing can rule out Turner syndrome.
- Measurement of growth hormone (GH) with stimulation testing.
Short Stature
- Height is less than the 3rd percentile or falls 2 standard deviations below the mean.
- Failure to grow more than 4 cm per year impacts 5% of the population.
- Constitutional delay means bone age is consistent with height age.
- Slow growth for the first 2 to 3 years of life then low-normal growth velocity is typical.
- Adults often have a family history of short stature and delayed puberty.
- In proportional short stature, extremities, head, and trunk grow proportionally as a result of intrauterine growth retardation, maternal/fetal infection, chromosomal abnormalities. Also possible is FTT, hypopituitarism, growth hormone deficiency, diabetes or hypothyroidism
- In disproportionate stature, smaller extremities relative to the head.
- Achondroplasia results in short arms and legs relative to the head/trunk, while rickets (Vitamin D deficiency) causes delayed growth, bow legs, weakness, and pain in the spine and legs.
- Down’s syndrome, which is a genetic chromosome 21 disorder can also impact physical/intellectual growth.
Constitutional Growth Delay
- It represents a common growth pattern variation/ not considered a disease.
- Child has no evidence of chronic illness, having a delayed bone age with normal growth velocity.
- Normal adult height is generally reached, albeit slightly shorter than family members: normal birth length/weight; slower linear growth between ages 1 and 3, height <3rd percentile, and delayed pubertal development.
- Refer to an endocrinologist to differentiate between CGD and GHD.
Disorders of Puberty
- True precocious puberty: early onset of multiple puberty features: accelerated linear growth, breast development, and penile enlargement/pubic hair development.
- Delayed puberty: lack of clinical features of puberty beyond age 14 (boys) or 13 (girls): girls should progress to menarche within 5 years of breast budding, and boys should attain tanner 5 status within 4.5 years of puberty initiation, refer to endocrinologist for evaluation of hypogonadism.
Children and Diabetes
- Diabetes is the 3rd most common chronic disease in childhood; roughly 208,000 individuals under 20 in the US are affected (2.2/1000).
- This is a syndrome of disordered metabolism and inappropriate hyperglycemia from either an absolute insulin deficiency or diminished biological effectiveness
- Type 1 (insulin deficiency): usually appears early with acute onset and relates to Human leukocyte antigens (HLA-DR3 or HLA-DR4) - destruction of pancreatic islet cells (autoimmune process), and often includes ketones in blood /urine.
Diabetes Mellitus Type 1 Signs and Symptoms
- The 3 Ps are polyuria, polydipsia, polyphagia.
- Other signs include nocturnal enuresis, weight loss with increased hunger, fatigue, weakness, paresthesia, LOC changes (irritability to coma), loss of SQ fat/muscle wasting, dysfunction of peripheral sensory nerves, dehydration, and diminished Deep Tendon Reflexes.
Diabetes In Youth Type 1
- Age of onset is all ages with distribution equal among everyone.
- It impacts more non-Hispanic whites, but everyone is affected.
- There is no link to obesity to type 1 diabetes.
- Around 5%-10% have 1st degree relative, with very low insulin secretion, but normal insulin sensitivity.
- Onset begins acute and manifests with Ketosis or DKA in 1/3 of new cases.
- Hypertension is uncommon but Islet autoimmunity is present
Labs and Diagnostics for Diabetes
- Elevated serum fasting glucose levels with values ≥ 126 mg/dL on two separate occasions indicate diabetes.
- High random blood sugar reads ≥ 200 mg/dL, shows hyperglycemia.
- Glucose levels are elevated by ≥ 200mg/dL after eating, demonstrating issues with metabolism.
- Low C-peptide levels and presence of autoimmune markers are consistent with Type 1 DM.
- Urine samples should be tested for presence of glucose/ketones.
- A CMP can be used to screen for acid-base, DKA, or plasma ketones.
- Check to make sure that serum BUN and creatinine are elevated.
- Elevated Hgb A1c is usually at or greater than 6.5% along and screenings for thyroid autoantibodies.
Diabetes Management
- Rather that base glycemic control on age, the new standard is maintain a HgbA1C less than 7.5% for all youth.
- Insulin is started at diagnosis and blood glucose will continue to be monitored.
- Dietary and diabetes education is important for nutrition and lifestyle.
- Blood glucose monitoring is an important tool to determine hyper or hypoglycemia.
Diabetes in Youth Type 2
- Age of onset tends to present in those >10 years of age and is common to everyone.
- This is more frequent in Blacks, Asians, Native Americans, Hispanics, with > 90% link to obesity
- Around 80% have 1st degree relative, Low, normal or high secretions, decreased Islet sensitivities
- It shows subtle to severe symptoms with Ketosis is an uncommon sign, while hypertension is common + PCOS.
Type 2 Diabetes goals
- The plan must be individualized with Hgb A1C less than or equal to 7%, LDL < 100 mg/dL, HDL >45 mg/dL, and Triglycerides < than 125 mg/dL
- There has to be continuous Control of hypertension and hyperlipidemia.
- Follow up has routine annual check-ups as well annual urine test, q3-4 months testing of (HbgA1C) of glucose levels.
Type 2 DM Management
- Patients with Hgb A1C 7%-10% show initial treatment, support lifestyle changes with nutrition and 60 minutes of exercise thrice weekly.
- Metformin is a first-line pharmacotherapy for 3-6 months, but if Hgb A1C remains <7% is not achieved in 3-6 months consider metformin, and addition of insulin if those does not achieve goals.
Thyroid Screening
- The best screening test for detecting hyperthyroidism, as well as hypothyroidism is the TSH level; if abnormal, additional tests must be ordered.
Delayed Puberty
- Refer 16 year olds to an endocrinologist if there is no appearance of secondary sex characteristics; specifically no testes by 14 years of age.
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