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  1. Preoperative evaluation for elective surgery should include assessment of glycemic control (glycohemoglobin and serum blood sugar), electrolyte status, and presence or absence of ketones. Additional testing is dictated by patient comorbidities.

  2. Patients who use glargine (Lantus®) should take their full dose on the evening prior to surgery or the morning of surgery and omit their short- or rapid-acting insulin dose on the day of surgery.

  3. Hyperglycemia impairs wound healing, decreases chemotaxis and phagocytosis, and has been shown to increase rate of surgical infection.

  4. Graves disease, an autoimmune disease producing TSH-receptor stimulating antibodies resulting in excess production and release of T3 and T4, is the most common cause of hyperthyroidism in children and adolescents.

  5. Postoperative thyroid surgery concerns include hypocalcemia from parathyroid trauma causing muscle weakness, respiratory insufficiency due to vocal cord paresis/paralysis, tracheomalacia from a large compressive tumor, and obstruction from surgical site hematoma.

  6. The average age of presentation of pheochromocytomas (PCC) and paragangliomas (PGL) in pediatrics is 11 to 13 years, with presentation varying from headaches, sweating, flushing, and nausea to paroxysmal and sustained hypertension.

  7. Prior to resection of PCC and PGL, α-blockade and fluid resuscitation should be initiated followed by β-blockade. The order of blockade is critical to prevent the unopposed β effect resulting in cardiac dysfunction and pulmonary edema.

  8. Post PCC and PGL resection, profound hypotension may require vasopressin infusion.


Diabetes Mellitus

Diabetes mellitus (DM) is hallmarked by the dysregulation of glucose homeostasis leading to hyperglycemia. The causes may be attributed to absence of insulin, diminished insulin levels, or insensitivity of the peripheral tissues to insulin. Gluconeogenesis and lipolysis are affected and may result in lactic acidosis and ketosis. The incidence and prevalence of all diabetes types appear to be on the rise. According to Centers for Disease Control and Prevention (CDC) data, approximately 200,000 children and adolescents are affected across the United States.1 The mortality rates from diabetes and its complications among young people appear to be stable at approximately 1/1,000,000. Diabetes may be divided into the following subtypes that define some of the pathophysiological processes.2,3

  • Type 1 diabetes mellitus (DM-1)

  • Type 2 diabetes mellitus (DM-2)

  • Genetic defect of β-cell function

    • Mature onset diabetes of the young (MODY)3,4

    • Mitochondrial disorders

  • Exocrine pancreas disease

    • Cystic fibrosis

    • Thalassemia

    • Congenital rubella

  • Insulin resistance

    • Rabson-Mendenhall

  • Endocrinopathies

    • Autoimmune polyglandular syndrome

    • Cushing syndrome

  • Drug induced

  • Steroids

  • Chemotherapy agents

  • Genetic

    • Down syndrome

    • Klinefelter syndrome

    • Myotonic dystrophy

    • Prader-Willi syndrome

    • Turner syndrome

    • Werner syndrome

    • Wolfram syndrome

DM-1 is characterized by autoimmune-mediated pancreatic insulin-secreting β-cell destruction, and an absolute deficiency of insulin. New theories on etiology link onset of autoimmune DM-1 (anti-pancreatic β-cell) to genetic susceptibility and to an infectious etiology, as diagnosis rates increase during autumn and winter months mirroring increased rates of viral infections in the pediatric population.2 The prevalence of DM-1 in ...

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