Developmental Assessment Flashcards
At what age does puberty normally stop/aka at what age do you stop growing?
16-18 years
Is it abnormal to stop growing at age 13?
Not necessarily - may have started and then stopped puberty earlier
When do girls have their most rapid growth during puberty?
Age 12-13
When do boys have their most rapid growth during puberty?
Age 14-15
Which part of the bone is open during puberty and then closes, preventing growth?
The epiphysis
How do we measure growth?
Height
Head circumference
What difference between chronological age and bone age is a cause for concern?
Greater than 2 years either side
What is the major reason for an older bone age than chronological age?
Precocious puberty
How do you calculate height velocity?
height difference / time difference
What are the causes of short stature? (6)
- Inherited/familial
- Chromosomal - consider Turner’s, achondroplasia
- Nutrition
- Hormonal (growth hormone deficiency)
- Inflammatory (chronic illness)
- Psychological and emotional
What are the endocrine abnormalities that can lead to short statute?
- Hypothyroidism
- Growth hormone deficiency
- Cushing’s disease (ACTH secreting pit adenoma)
- Diabetes - if poorly controlled
- Delayed/precocious puberty
Which is more worrying - short and fat or tall and fat?
Short and fat - pathological obesity
If a child is short and thin (not in keeping with parents height/weight), what is a possible cause?
Chronic disease
How does puberty present in a girl?
Breast budding aka thelarche
What is the sequence of puberty in a girl?
Breast budding –> pubic and axillary hair development –> menarche at end of puberty
What is the sequence of puberty in a boy?
Increase in testicular volume –> pubic and axillary hair development and deepening voice –> voice broken, facial hair, increase in penis size
At wha age is precocious puberty (early onset of secondary sexual characteristics)?
In girls before the age of 8 and in boys before the age of 9
What is the term given to central precocious puberty?
Concordant
What is the term given to the source of sex steroids not under gonadotrophin control (testes develop on their own)?
Discordant
What is virilisation?
Increased adrenal androgen secretion
What is premature thelarche?
Isolated breast development
What are the possible investigations for precocious puberty? (6)
- Bone age
- TFTs
- Oestrodiol/testosterone
- Pituitary function tests
- Scan pelvis and adrenals
- MRI
What is classed as delayed puberty in girls and boys?
In girls - no sign of puberty by age 13, and menarche after 15 years
In boys - no signs of puberty by age 14
What are the possible investigations for delayed puberty? (7)
- Bone age
- Karyotype
- Coeliac disease
- TFTs
- FBC, U&Es
- LH/FSH/oestrogen/testosterone
- Consider imaging: MRI/pelvic USS
Why it is important to look out for pubertal arrest?
It can be a sign of CNS tumour - prolactinoma
In suspected Turner’s syndrome, what tests need to be performed due to associations with Turner’s syndrome?
Echo - aortic problems associated
USS kidney + U&Es - kidney problems associated
