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Endocrine > Childhood growth and puberty > Flashcards

Childhood growth and puberty Flashcards

1
Q

The most rapid growth occurs during the _______ phase

A

in utero

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2
Q

What drives growth during fetal life?

A

IGF-1, insulin

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3
Q

What drives growth during childhood?

A

growth hromone

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4
Q

What drives growth during infancy?

A

nutritional status

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5
Q

What drives growth during the pubertal growth spurt?

A

stimulation of growth plate by androgens, estrogen, GH

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6
Q

List factors that stimulate GH secretion

A

GHRH

estrogen and androgens enhance GH response to GHRH

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7
Q

What factors inhibit GH secretion

A

somatostatin
high levels of glucocorticoids
GH and IGF-1 feedback, which increases somatostatin

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8
Q

What might explain the poor correlation of total IGF-1 levels with growth?

A

circulating IGF-1 is likely not the most important mediator of GH effect- GH stimulates local production of IGF-1 in tissues, which exerts an autocrine growth promoting
effec

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9
Q

Describe the effects of GH and IGF-1 on bone

A

GH: linear growth by action at epiphyseal growth plate

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10
Q

Describe GH effects on adipose tissue

A

utilization of fat for energy, sparing lean body mass
increase synthesis of hormone sensitive lipase (hydrolyzes TGs)
inhibits lipoprotein lipase

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11
Q

Describe GH effects on muscle

A

increased muscle mass, increased protein synthesis

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12
Q

Describe GH effects on carbohydrate metabolism

A

insulin resistance and glucose sparing

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13
Q

Differences in childhood _______ largely determine differences in adult height

A

growth velocity

disparity in heights of children at start of puberty= disparity in height in adulthood

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14
Q

Growth velocity is most rapid in utero and during the first year of life, when ______ factors predominate

A

nutritionally- derived, ex insulin

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15
Q

As the transition to GH dependent growth occurs, growth velocity ________

A

decreases

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16
Q

The greater the delay in the onset of puberty, the _______ the pre-pubertal growth rate

A

slower

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17
Q

Crossing of growth percentiles is common during _______ years of life

A

first 2 years- baby “seeks out” appropriate growth channel based on genetics
not normal to cross percentile lines from age 3- adolescence

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18
Q

What growth pattern is suspected if:

  • growth velocity is steady along low percentile lines
  • bone age= chronological age
A

intrinsic short stature

check MPH to verify

19
Q

If a child has intrinsic short stature but is significantly smaller than predicted by MPH, what causes should be considered?

A

mild hypochondroplasia
chromosomal disorders- Turners
in utero insults

20
Q

What growth pattern is suspected if:

  • growth velocity along low percentile lines
  • bone age
A

constitutional delay of growth and puberty

21
Q

What causes short stature during childhood in constitutional growth delay?

A

transition from the rapid growth phase of infancy to the slower growth of childhood occurs much earlier than normal

  • expect crossing down of percentiles at 10-30 months
22
Q

In ________ growth pattern, growth velocity is abnormally slow

A

attenuated

23
Q

What are some causes of attenuated growth pattern

A
  • nutritional deficiencies
  • chronic disease
  • severe emotional disorders
  • medications- corticosteroids, methylphenidate
24
Q

Hormonal alterations tend to cause marked retardation in linear growth with what effects on weight?

A

continued weight gain- usually stays along the same weight percentile

25
Q

Accelerated growth is usually associated with _______

A

obesity

26
Q

Why are infants with GH deficiency usually a normal size at birth

A

GH is not critical for in utero growth

27
Q

What clinical signs might indicate Gh deficiency

A

multiple midline defects including cleft palate, poor development of nasal bridge
cherubic faces
lack of phallic growth in males

28
Q

What are some FDA approved uses for GH therapy

A
  • GH deficiency
  • Turner, Prader-Willi
  • IUGR
  • chronic renal insufficiency
29
Q

Define gonadarche, thelarche, adrenarche, menarche

A
  • gonadarche: maturation of testes or ovaries to produce hormones
  • thelarche: breast budding (nl-10 yrs)
  • adrenarche: maturation of adrenal gland (age 6-8 yrs)
  • menarche: normal is about 12 yrs
30
Q

What are the findings in premature thelarche?

A

Early breast development without growth acceleration, bone age advancement, other signs of puberty

31
Q

Describe transient gynecomastia common in boys

A

breast development- high testosterone in puberty is aromatized to estradiol, stimulates temporary growth in breast tissue

32
Q

What are the findings in premature adrenarche?

A

early maturation of adrenal gland, but no gonadal changes so no bone advancement, acceleration in growth velocity

33
Q

________ is a hypothalamic protein that signals GnRH pulses to begin in puberty

A

kisspeptin

34
Q

What is the current definition of precocious puberty?

A

hanges occurring before the age of 7 to 8 years in girls and 9 years in boys

35
Q

What is the current definition of delayed puberty?

A

For girls, no thelarche by age 14 or menarche by age 16 years.
For boys, no testicular changes by age 15 years

36
Q

Describe the two categories of delayed puberty

A

Hypogonadotropic: Low LH and FSH, due to CNS defect.

Hypergonadotropic: High LH and FSH, due to defect in gonad.

37
Q

What are some causes of hypogonadotropic delayed puberty?

A

hypothalamic or pituitary disease, malnutrition, chronic disease, familial syndromes, and endocrine diseases.

38
Q

What are some causes of hypergonadotropic delayed puberty?

A

chemotherapy, radiation, trauma, inflammation, or infiltration of the gonads, and chromosomal disorders such as Turner syndrome.

39
Q

Differentiate central vs peripheral precocious puberty

A

CPP is caused by premature activation of the HP axis. Gonadotropins are in pubertal ranges.

PPP is not under the control of the central nervous system. Can arise in a gonad, a tumor, or another organ. Gonadotropins are low- suppressed by feedback from the abnormal sex hormone production

40
Q

How is CPP diagnosed?

A

increased LH/FSH secretion in response to GnRH stimulation testing

41
Q

How is CPP treated?

A

long acting GnRH analogs, which stop pulsatile release

42
Q

What is McCune-Albright syndrome?

A

G-protein activating mutation that can present as PPP, Cushing syndrome, or thyrotoxicosis.
Children have characteristic caféau- lait macules, polyostotic fibrous dysplasia, rapid growth

43
Q

What is familial testotoxicosis?

A

male disorder with penile enlargement, pubic hair, behavior problems
due to constitutively active LH receptor

Endocrine (19 decks)

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