Core Revision
DCH Revision Guide · Chapter 9
Endocrinology, growth and diabetes
Why it matters in the exam
This chapter contains the single most dangerous missed diagnosis in general practice paediatrics: new-onset type 1 diabetes. Children still die of diabetic ketoacidosis because a thirsty, tired child was sent away without a blood glucose. The DCH will test this, and it will not be subtle about the stem — but candidates still choose the wrong answer by arranging tests for "next week".
Around it sit the bread-and-butter endocrine topics: growth, short stature, thyroid disease and puberty. Growth is the great paediatric vital sign; learn to interpret a chart and you will pick up marks across the whole exam.
What this chapter covers
- 9.1Type 1 diabetes: refer the same daySuspect diabetes in any child with polyuria, polydipsia, weight loss, tiredness, or new bedwetting in a previo…Preview below
- 9.2Diabetic ketoacidosisDKA is defined by acidosis (pH below 7.3 or bicarbonate below 15 mmol/L), ketonaemia, and hyperglycaemia (thou…Members
- 9.3Living with type 1 diabetesModern paediatric care means multiple daily injections or insulin pump therapy, continuous glucose monitoring…Members
- 9.4Growth: how to read the chartUse the UK-WHO growth charts (0–4 years) and UK90 charts thereafter; plot preterm babies using corrected age u…Members
- 9.5Thyroid diseaseMembers
- 9.6PubertyNormal puberty begins with breast budding in girls (from about 8–13 years) and testicular enlargement (4 mL) i…Members
- 9.7ObesityUse BMI plotted on a BMI centile chart for age and sex, not adult cut-offs. Nearly all childhood obesity is ex…Members
- —Common pitfalls · Exam triggersMembers
The core content
Type 1 diabetes: refer the same day
Suspect diabetes in any child with polyuria, polydipsia, weight loss, tiredness, or new bedwetting in a previously dry child. Recurrent thrush and blurred vision are supporting clues.
- Measure a capillary blood glucose immediately. If it is raised, refer to a specialist paediatric diabetes team for assessment on the same day — not to a clinic next week, and not with an HbA1c and a follow-up.
- Check for ketones and for signs of DKA: vomiting, abdominal pain, dehydration, deep sighing (Kussmaul) breathing, the smell of ketones, drowsiness.
- Do not wait for confirmatory tests before referring. Children decompensate quickly.
In children and young people, type 1 remains the most likely diagnosis, though type 2 is rising with obesity. Presentation with DKA at diagnosis is common and largely preventable by earlier recognition.
The rest of this chapter is in the DCH guide
6 more sections, the pitfalls examiners set, and the exam triggers for this topic — written and reviewed by practising UK doctors.
All 12 chapters of the DCH revision guide · DCH question bank