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Endocrine presentations - Coggle Diagram

- - - - ?Brittle hair?
    - - From above - exophthalmos/proptosis
      - Lid lag? Lid retraction? Lid oedema?
      - Eye movements
    - - Visible goitre?
      - Palpable goitre?
        
        Moves on swallowing?
        
        Moves on protrusion of tongue?
      - If present, percuss lower border
    - - Skin
      - Heart
    - - Tenderness
      - Bowel sounds?
    - - Ankle jerk reflex
      - Get up from chair
      - Pre-tibial myxoedema?
    - - Pulse and BP (wide pulse pressure and high BP - hyperthyroidism
      - Clammy?
      - Tremor
      - Palmar erythema - hypothyroidism?
      - Thyroid acropachy - similar to clubbing
    - - Well?
      - Anxious? Lethargic?
      - Body habitus?
    - - Growth
      - Pubertal assessment
  - - - Cong
        
        Agenesis
        
        Ectopic gland
      - Acq
        
        Autoimmune
        
        Post thyroidectomy
        
        Iodine deficiency
    - - Cong
        
        Hypopituarism, eg septooptic dysplasia
      - Acq
        
        Tumours
        
        radiotherapy
        
        Brain surgery
- - - - Breasts
      - Axillary hair
      - Pubic hair
    - - Testicular volume
      - Axillary hair
      - Pubic hair
      - Penile development
  - - - Central
        
        Idiopathic
        
        Secondary
        
        Tumours
        
        Trauma
        
        Cranial irratiation
        
        Hyperthyroidism
        
        Hydrocephalus
        
        NF1
      - Non Central
        
        McCune-Albright
        
        Deformities and fractures
        
        Cafe au lait spots on one side of the body
        
        Endocrinopathies
        
        PP, as early as age 2!
        
        Hyperthyroidism
        
        Cushing's
        
        Genetic mutation leading to abnormal activation of a protein that is involved in cell surface receptors
        
        As a result, get activation of TSH/ACTH/LH/FSH receptors
        
        CAH
        
        Adrenal tumours
        
        Gonadal tumours
        
        Cushing's
    - - HPC
        
        Features of, with timings of each
        
        Tall stature?
        
        Growth rate?
        
        Breast/testes/Penile development
        
        Axilalry hair
        
        Pubic hair
        
        Adult body odour
        
        Mood swings
      - PMHx
        
        Previous tumours?
        Or treatmemt for
        
        Features of CAH
        
        Tiredness
        
        Frequent illness?
        
        Thyroid?
        
        Growth?
        
        DI?
        
        Symptoms of CNS tumour?
        
        Previous trauma?
        
        Abdominal pain/testicular masses?
      - FHx
        
        Parental puberty
        
        Sibling puberty
    - - Adrenal androgens
        
        testosterone
        
        Androstenidione
        
        17OHP
        
        DHEAS
        
        E2 in girls
      - All baseline pituitary function
        
        TSH
        
        GH (IGF1)
        
        Morning cortisol
        
        FSH/LH
      - Wrist xray for bone age
      - Abdo/pelvis USS
      - Urinary steroid profile
      - LHRH test
        
        If LH more prominent, then in puberty
      - MRI brain (boys)
    - - GnRH analogues in central
  - - - Intact axis
        
        CDGP
        
        Chronic disease
        
        Poor nutrition
        
        Psychosocial deprivation
        
        Long-term steroids
        
        Hypothyroidism
      - Deranged axis
        (Hypogonadotrophic hypogonadism)
        
        Tumours
        
        Septo-optic dysplasia
        
        Congenital hypopituarism
        
        Acquired hypopituarism
        
        Radiotherapy
        
        Trauma
        
        Surgery
        
        GnRH/LH/FSH deficiencies
        
        Idiopathic
        
        Kallmann Sx (remember anosmia)
        
        Prader Willi Sx
        
        Bardet Biedl Sx
        
        CHARGE syndrome
      - Axis is working (high feedback)
        (Hypergonadothrophic Hypogonadism)
        
        Bilateral testicular damage
        
        Syndromes associated with cryptorchidism
        
        Noonan
        
        Prader Willi
        
        Bardet-Biedl
        
        Ovarian failure
        
        Damage
        
        Dysgenesis
        
        Turner's
        
        General
        
        Short staure
        
        Head
        
        Prominent ears
        
        Neck webbing
        
        High-arched palate
        
        Grommets - glue ear
        
        Low posterior hairline
        
        Arms
        
        Weak peripheral pulses - ?coarct
        
        Widened carrying angle
        
        Chest
        
        Scars from cardiac surgery
        
        Wide-spaced nipples
        
        Lack of breast development
        
        Naevi and cafe au lait spots
        
        Murmur - ? coarctation
        
        To complete
        
        Thyroid status
        
        CVS exam
        
        Pubertal staging
        
        Heaight and weight on a TURNER'S Growth chart
        
        Ix
        
        Abdo USS - ?horsehoe kidney
        
        Audiology
        
        Cardiac echo
        
        Screening bloods - HbA1c, TFTs, Coeliac, LFTs
        
        Growth and puberty monitoring
        
        Noonan's
        
        PCOS
    - - Baseline pituitary function
        
        TSH
        
        IGF1
        
        PRL
        
        Cortisol
        
        FSH/LH
      - Oestradiol
      - Testosterone
      - Markers of chronic disease
        
        FBC
        
        ESR
        
        Coeliac
        
        UEs
      - Karyotype (DON'T MISS TURNER'S!)
      - Bone age
      - Pelvic USS
      - GnRH test
      - HCG test in boys for testicular function
      - MRI brain
- - - - Severe GIRD
      - Neglect
      - Poverty
      - Ricket's
      - IBD
      - Coeliac
    - - Any chronuc illness, or history of such
    - - GH deficiency
      - Hypothyroidism
      - Delayed puberty
      - History of precocious puberty
      - Excess corticosteroids
    - - Turner
      - Noonan
      - Russell-Silver
      - Prader Willi
    - - SGA/IUGR
  - - - INc Meds/smoking/alcohol - risk factors for septo-optic dysplasia
      - Inc abnormalities on scans
      - Inc Gesttation.Delivery, etc
    - - Feeding
      - Tone
      - Prolonged jaundice - can be presenting feature of septo-optic dysplasia
    - - Weaning
      - Feeding
      - Reflux
    - - Hospita admissionsl
      - Systems review
      - Recurrent infections
      - Thyroid symptoms
      - CNS symptoms
      - Puberty
    - - Steroids
    - - Country of origin
      - Consanguinuity
      - Sibling/parental growth and puberty
      - Anyone particulalry short
      - Any difficulty conceiving?
    - - Tyoe of school
      - School performance
      - ?Shortest in class
      - Social worker
      - Household
  - - - Growth charts
        
        See THIS
      - At the child
        
        Well?
        
        Underweight/overweight
        
        Proprtional or not?
        
        Dysmorphism?
        
        Neurocutaneous features
        
        Scoliosis
      - At the parents
        
        Are they short?
    - - Examine for the unwellness
    - - Thyroid
      - Cushing's
      - Gh def
      - Rickets
    - - Features plus complications
    - - Growth
      - Developmental
      - Pubertal
- - - - BM testing
        
        When get up
        
        Pre meals
        
        2hrs post meals
        
        Before bed
      - Insulin
        
        Rotate sites
      - General education on DM1
      - Hypos and how to treat
        
        < 4mmol/L
      - Sick-day rules
    - - Carb counting
      - Liaise with school
    - - q 4 months
      - Height, weight, BP
      - HbA1c
      - Review BMs
      - Assess treatment complicance
      - Assess ketone awareness
      - Assess hypo awareness
      - Check injection sites
      - Annual review
        
        Feet
        
        Urine Albumin:Cr
        
        Bloods
        
        HBA1c
        
        UEs
        
        Coeliac
        
        TFTs
        
        Lipids
  - - - If fails
        
        Kinks
        
        Battery
        
        Insulin run out?
- - - - Thyroid
      - Cushing's
    - - Syndromic
        
        Prader-Willi
        
        Hyperphagia and obesity
        
        Up-slanting, almond eyes
        
        Small hands and feet
        
        Hypotonia
        
        fish mouth
        
        Intellectual disability
        
        Bardet-Biedl
        
        Retinal degeneration
        
        Obesity
        
        Polydactylyl
        
        Hypogonadism
        
        Cognitive impairment
        
        Renal abnormalities
      - Monogenic
        
        Leptin def
        
        Melanocortin 4 receptor def
      - Polygenic
  - - - HPC
        
        When did you notice it, etc?
        
        What does the child eat?
        
        What are their physical activities like?
        
        What is their attitude to food?
        
        Are they tall/short?
        
        Are there any associated signs or symptoms
        
        Abnormally cold?
        
        Skin,hair changes?
        
        Abnormal body shape