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Iran Specialty Board - Pediatrics study materials
Iran Specialty Board - Pediatrics study resources

Iran Specialty Board - Pediatrics: Pediatric Endocrinology

Iran Specialty Board - Pediatrics · Work through your exam, one topic at a time.

All guide sections

Pediatric Endocrinology

This domain tests thyroid disease, disorders of growth and puberty, adrenal insufficiency and diabetic ketoacidosis.

Thyroid

  • Congenital hypothyroidism is detected on newborn screening (raised TSH); start levothyroxine 10-15 mcg/kg/day within 2 weeks of life to protect neurodevelopment.
  • Acquired hypothyroidism from Hashimoto thyroiditis causes growth failure, bradycardia and constipation with raised TSH and anti-thyroid peroxidase antibodies.

Growth and puberty

  • Growth hormone deficiency gives severe short stature with low growth velocity and delayed bone age; diagnose with stimulation testing and treat with recombinant hormone.
  • Constitutional delay shows delayed bone age matching delayed height age.
  • Precocious puberty: breast development before 8 years in girls or testicular enlargement before 9 years in boys; central causes respond to GnRH agonists.
  • Turner syndrome (45,X): short stature, webbed neck, coarctation, ovarian failure; treat with growth hormone.

Adrenal disorders

  • 21-hydroxylase deficiency causes 90% of congenital adrenal hyperplasia; salt-wasting forms show hyponatraemia, hyperkalaemia and ambiguous genitalia in females. Treat with hydrocortisone, fludrocortisone and sodium chloride.

Diabetic ketoacidosis

  • pH below 7.3, bicarbonate below 18 mmol/L, ketonaemia and dehydration.
  • Give 10-20 mL/kg isotonic saline, then a 0.05-0.1 unit/kg/hour insulin infusion started after potassium is known; add potassium once it falls below 5.5 mmol/L.
  • Bicarbonate only for pH below 6.9. Cerebral oedema is the feared complication; treat with hypertonic saline or mannitol.

Worked example

A 9-year-old presents with polyuria, glucose 500 mg/dL, pH 7.15, bicarbonate 8 mmol/L and ketonuria. Reasoning: this is DKA. Give isotonic fluid, confirm potassium, then start an insulin infusion at 0.05-0.1 unit/kg/hour and monitor neurological status hourly.

Traps

Giving an insulin bolus in paediatric DKA; giving bicarbonate routinely; and missing salt-wasting adrenal crisis in a neonate with hyperkalaemia.