PSYCH 1XX3 Lecture Notes - Lecture 6: Diuresis, Congenital Hypothyroidism, Hypovolemia
19 May 2018
School
Department
Course
Professor
ENDOCRINOLOGY
IDDM
• Genetic predisposition and environmental precipitants
• AI process which damages -cells in pancreas leading to absolute I def
• Associated with other AI disease e.g. hypothyroidism
• Dx: symptomatic child with raised random blood glucose (>11.1mmol/L) or fasting blood glucose of
>7.8mmol/L and raised HbA1c
• Presentation
o Most common: polydipsia, polyuria, wt loss
o Less common: enuresis, skin sepsis, candida and other infections
DKA
• Insulin def
• Aetiology: poor control, poor adherence, illness (inf), initial presentation
• I causes:
o Hyperglycaemia: hepatic production, uptake, proetolysis
o Osmotic diuresis: loss of water and electrolytes
o Dehydration: due to osmotic diuresis. Dehydration causes: CCA,cortisol,GH,AVP
o Ketosis: due to lypolysisFFsketone production
o Acidosis: due to ketones. Therefore metabolic acidosis +/- resp compensation
• Presentation
o Acetone on the breathe
o Vomiting
o Dehydration
o Abdo pain
o Hyperventilation (kussmaul breathing)
o Hypovolaemic shock
o Drowsiness
o Coma
Hypothyroidism
Congenital hypothyroidism
• Common and Rxable (i.e. preventable cause of learning diff).
• Causes:
o Maldescent of thyroid and athyrosis
o Dyshormonogenesis
o Iodine def:
o Hypothyroidism due to TSH def:
• Clinical features:
o FTT
o Feeding probs
o Prolonged jaundice
o Constipation
o Pale, cold, mottled skin
o Coarse facies
o Large tongue
o Hoarse cry
o Goitre (occasionally)
o Umbilical hernia
o Developmental delay
• Rx: lifelong oral thyroxine, titrating dose to maintain N growth, TSH and T4
Juvenile hypothyroisism
• Usually caused by AI thyroiditis
• More common in girls
• Clinical features:
o Short stature/growth
failure
o Cold intolerance
o Dry skin
o Cold peripheries
o Bradycardia
o Thin,dry hair
o Pale, puffy face
o Goitre
o Slow relaxing reflexes
o Constipation
o Delayed puberty
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