17. Paediatric Endocrinology and Diabetes Flashcards
What Factors influence Height?
- Age / Skeletal Maturity (Bone Age) / Puberty
- Sex / Race / Parental Heights
- General Health - Nutrition / Chronic Disease
- Specific Growth Disorders
- Socio-Economic Status
- Emotional Well-Being
What are the Different Techniques for Measuring Height?
- Length
- Height
- Sitting Height
- Head Circumference
What needs to be looked for in a Paediatric History / Further Examination?
- Birth Weight and Gestation
- Past Medical History
- Family / Social History / Schooling
- Systemic Enquiry
- Dysmorphic Features
- Systemic Examination - including Pubertal Assessment
What are the Assessment Tools used to Assess Growth?
- Height / Length / Weight
- Growth Charts and Plotting
- Mean Parental Heights / Target Centiles
- Growth Velocity
- Bone Age
- Pubertal Assessment
What are the Indications for Growth Disorder Referral?
- Extreme Short / Tall Stature
- Height Below Target Height
- Abnormal Height Velocity
- History of Chronic Disease
- Obvious Dysmorphic Syndrome
- Early / Late Puberty
What are the Common Causes of Short Stature?
- Familial
- Constitutional
- Small for Gestational Age
- Intra-Uterine Growth Restriction
What are the Pathological Causes of Short Stature?
- Undernutrition
- Chronic Illness - JCA / IBD / Coeliac
- Iatrogenic - Streoids
- Psychological and Social
- Hormonal - GHD / Hypothyroidism
- Syndromes - Turners / Prader-Willi
What does a Full Blood Count and Ferritin look for?
- General Health
- Coeliac Disease
- Crohn’s Disease
- Juvenile Chronic Arthritis
What does a U&E’s / LFT’s / Ca / CRP look for?
- General Health
- Renal and Liver Disease
- Disorders of Ca Metabolism
What is Coeliac Serology and IgA looking for?
Coeliac Disease
What does a IGF-1 / TFT / Prolactin / Cortisol look for?
Hormone Disorders
What does a Karyotype Look for?
Turner’s Syndrome
What is included in the Tanner Method of Puberty Staging?
- Breast Development - 1 to 5
- Genital Development - 1 to 5
- Pubic Hair Development - 1 to 5
- Axillary Hair Development - 1 to 3
- Testis - 2ml to 20mls
- SO - e.g. Statement as B3 PH3 / G2 PH2 6/6
What is Early (a) / Delayed (b) Puberty for:
- Boys?
- Girls?
- a) Early Boys - < 9 years - Rare
- b) Late Boys - > 14 years - common,
- a) Early Girls - <8 years
- b) Late Girls - > 13 years - Rare
What are the Features of Constitutional Delay of Growth and Puberty (CDGP)?
- Boys Mainly
- Family History in Dad / Brothers
- Bone Age Delay
- Need to Exclude Organic Disease
What are Causes of Constitutional Delay of Growth and Puberty (CDGP)?
- Gonadal Dysgenesis - Turner (45X) / Klinefelter (47XXY)
- Chronic Disease - Crohn’s / Asthma
- Impaired Hypothalamic-Pituitary-Gonadal (HPG) Axis:
- a) Septo-Optic Dysplasia
- b) Craniopharyngioma
- c) Kallman’s Syndrome
- Peripheral - Cryptorchidism / Testicular Irradiation
What is the cause of Early Breast Development?
Hypothalamic Activation:
- Infantile Thelarche
- Thelarche Variant - Premature Thelarche
- Central Precocious Puberty
What is the cause of Early Secondary Sexual Characteristic Development?
Sex-Steroid Hormone Secretion:
- Exaggerated Adrenarche
- Precocious Pseudopuberty - Congenital Adrenal Hyperplasia
What is the cause of Early Per-Vaginal Bleeding?
Premature Menarche
What are the Features of Central Precocious Puberty?
- Pubertal Development - Breasts / Testicular
- Growth Spurt
- Advanced Bone Age
Note - Need to Exclude a Pituitary Lesion
What are the Features of Precocious Pseudopuberty?
- Abnormal Sex-Steroid Hormone Secretion
- Gonadotrophin Independent - Low / Prepubertal Levels of LH and FSH
- Clinical Picture - Secondary Sexual Characteristics
Note - Need to Exclude Congenital Adrenal Hyperplasia
What are the Features of Congenital Hypothyroidism?
- Caused by:
- a) Athyreosis / Hypoplastic / Ectopic
- b) Dyshormonogenic
- Newborn Screening
- Start Treatment within the First 2 Weeks
What are the Features of Acquired Hypothyroidism?
- Autoimmune Thyroiditis - Most Common Cause
- Family History of Thyroid / Autoimmune Disorders
- Childhood Issues:
- a) Lack of Height Gain
- b) Pubertal Delay
- c) Poor School Performance
What is assessed in an Obese Child?
- Weight
- Body Mass Index (BMI) - Kg/m^2
- Height
- Waist Circumference
- Skin Folds
- History and Examination
- Complications
What should be looked for / at in an Obese Child?
- Diet / Physical Activity
- Family History
- Symptoms Suggestive of:
- a) Syndrome
- b) Hypothalamic-Pituitary Pathology
- c) Endocrinopathy
- d) Diabetes
- Drug History
What are the Symptoms of Diabetic Ketoacidosis?
- Nausea and Vomiting
- Abdominal Pain
- Sweet Smelling, Ketotic Breath
- Drowsiness
- Rapid, Deep, Sighing Respiration
- Coma
