Endocrine Flashcards
What are the three phases of normal growth?
Infantile
Childhood
Pubertal
What are the measurements for assessing child growth?
Length/Height
Sitting height
Head circumference
What is the current chart for plotting child growth?
RCPCH UK2-18 growth chart
What chart would you use to plot against parents height?
Target height and mid parental heigh (MPH)
What other test can be used to plot growth/growth potential?
Bone age: TW 20
What are the complete assessment tools for child growth?
Height/length/weight Growth charts and plotting MPH and target centiles Growth velocity Bone age Pubertal assessment
What would you ask in a Hx about growth?
Birth weight and gestation PMx Fx/Sx/schooling Systematic enquiry Dysmorphic features Systemic examination including pubertal assessment
What are indictions for referral on suspicion of a growth disorder?
Extreme short/tall stature Height below target height Abnormal height velocity History of chronic disease Obvious dysmorphic syndrome Early/late puberty
What are some common causes of short stature?
Familial
Constitutional
SGA/IUGR
What are some pathological causes of short stature?
Undernutrition Chronic illness (JCA, IBD, coeliac) Iatrogenic (steroids) Psychological and social Hormonal (GHD, hypothyroidism) Syndromes (Turner, P-W)
What are investigations for looking at small stature?
FBC and ferritin U&E, LFT, Ca, CRP Coeliac serology and IgA IGF-1, TFT, prolactin, cortisol Karyotype
What does FBC and ferritin investigate re: short stature?
General health, coeliac, Crohn’s, JCA
What does Ca investigate re: short stature?
Disorders of Ca metabolism
What do IGF-1, TFT, prolactin and cortisol investigate re: short stature?
Hormonal disorders
What does doing a karyotype investigate re: short stature?
Turner’s syndrome
What can be given to activate a GH stimulation test?
Arginine test
Insulin tolerance test
If someone fails the GH stimulation test what does this mean?
GH deficiency
What are two malformations of the pituitary gland which can result in GH deficiency?
Ectopic pituitary gland
Small pituitary gland
What is the typical presentation of thyroid deficiency?
Lost height
Gained weight
What are the signs of Turner syndrome?
L
What is the staging system of puberty called?
Tanner method
What are the signs of Prader-Willi syndrome?
D
What are the signs of Noonan’s syndrome?
D
What is the Tanner method of staging puberty?
B - breast G - genital PH - pubic hair AH - axillary hair T - testes
How is the Tanner method assessed?
Clinical examination
What is the device used to measure testicular maturation?
Prader orchidometer
Which Tanner stage is pubertal?
Stage 2
Which Tanner stage is pre-pubertal?
Stage 1
What is the first sign of puberty in females?
Breast budding
What happens at the end of puberty in females?
Menarche
What happens at the end of puberty in males?
Facial hair
What is the first sign of puberty in males?
Testicular growth
When is early puberty in males?
> 9yrs
When is delayed puberty in males?
> 14yrs
When is delayed puberty in females?
> 13yrs
When is early puberty in females?
<8yrs
What is CDGP?
Constitutional delay of growth and puberty (CDGP)
Who does CDGP mainly affect?
Boys
FH
Bone age delay
What are some causes of delayed puberty?
Gonadal dysgenesis (Turner, Klinefelter)
Chronic disease
Impaired HPG axis
Peripheral (cryptorchidim)
What happens if adrenal glands sex hormones are activated earlier?
Adrenarche
What is adrenarche?
Development of pubic hair/axillary hair
Where does true precocious puberty begin?
Pituitary gland
What would you need to exclude if premature secondary sexual characteristics?
Congenital adrenal hyperplasia
What is precocious pseudopuberty?
Abnormal sex steroid hormone secretion
What is the clinical picture of precocious pseudopuberty?
Secondary sexual characteristics
What is the management approach towards ambiguous genitalia?
Do not guess sex MDT Examination Karyotype Exclude congenital adrenal hyperplasia
Why should you exclude congenital adrenal hyperplasia in ambiguous genitalia?
Risk of adrenal crisis and death
Which Tanner stage is breast budding in girls?
Tanner Stage B2
What Tanner stage is testicular enlargement?
Tanner Stage G2
T3-4ml
What can cause congenital hypothyroidism?
Athyreosis/hypoplastic/ectopic
Dyshormongenic
How is congenital hypothyroidism managed?
Newborn screening
Treatment within first two weeks
What is the most common cause of acquired hypothyroidism?
Autoimmune (Hashimoto’s) thyroiditis
What are the childhood problems that present with acquired hypothyroidism?
Lack of height gain
Pubertal delay
Poor school performance
Obesity
When should you worry about an obese child?
Obese + short = abnormal
What are the causes of obesity in children?
Simple obesity Drugs Syndromes Endocrine Hypothalamic damage
What are the THINK type I diabetes symptoms?
Thirsty
Thinner
Tired
Toilet - more
What are the steps to making an early diagnosis of type I diabetes?
THINK symptoms
TEST
TELEPHONE
What is the immediate test for type I diabetes in children?
Finger prick capillary glucose test
>11mmol/l -> refer
What is a red flag symptom of type I diabetes?
Return to bed-wetting
Day-wetting
What signs should you look for in >5s with possible type I diabetes?
Heavier than usual nappies Blurred vision Candidiasis Constipation Recurring skin infections Irritability/behaviour change
What are symptoms of DKA?
Nausea & vomiting Abdominal pain Sweet smelling ‘ketotic’ breath Drowsiness Rapid, deep ‘sighing’ respiration Coma
What result of the finger prick capillary blood glucose test indicates type I diabetes in children?
> 11mmol/l
