Endocrine Flashcards
What are some factors influencing height?
Age Sex Race Nutrition Parental heights Puberty Skeletal maturity General health Chronic disease Specific growth disorders Socio-economic status Emotional well-being
What are some measurements techniques used to asses growth?
Height Length Sitting height Occipitofrontal circumference Condition specific growth charts. Mid Parental Height (MPH) Bone age Pubertal assessment
What are some indications for referral for growth disorders?
Extreme short or tall stature (off centiles)
Height below target height
Abnormal height velocity (crossing centiles)
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?
Under nutrition Chronic illness (JCA, IBD, Coeliac's) Iatrogenic (steroids) Psychological and social Hormonal (GHD, hypothyroidism) Syndromes (Turner's, P-W)
What investigations would you carry out to test for pathological cause of short stature?
FBC Ferritin U&Es LFT Calcium CRP Coeliac serology IgA IGF-1 TFT Prolactin Cortisol Gonadotrophins Karyotype
Hoe is Puberty staged?
Tanner method B - 1 to 5 breast development G - 1 to 5 genital development PH - 1 to 5 pubic hair AH - 1 to 3 axillary hair T - 2ml to 20ml SO
Unless adequately trained use the Puberty Phases approach.
Prader Orchidometer to measure testicular maturation
What is considered early puberty?
Boys = < 9 years (rare) Girls = <8 years
What is considered delayed puberty?
Boys = >14 years (common) Girls = > 13 years (rare)
What is Constitutional Delay of Growth and Puberty (CDGP)?
Affects boys mainly.
Family history in Dad or brothers.
Bone age delay
Need to exclude organic disease.
What are some other causes of delayed puberty?
Gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
Chronic disease (Crohn’s, asthma)
Impaired HPG axis ( sept-optic dysplasia, craniopharyngioma, Kallman;s syndrome)
Peripheral (cryptorchidism, testicular irradiation).
What is thelarche?
Stage at which male and female breasts become distinct due to variance in hormone levels
What is precocious pesudopuberty?
Partial pubertal development that results from autonomous (gonadotropin-independent) production of testosterone in a prepubertal boy. Affected boys have premature virilization and rapid growth, but they do not produce sperm.
Secondary asexual characteristics.
Need to exclude congenital adrenal hyperplasia.
What is Central precocious puberty?
Early breast development in girls and testicular enlargement in boys.
Growth spurt
Advanced bone age
Need to exclude pituitary lesion with MRI.
What is the management approach for Ambiguous genitalia?
Do not guess sex
MDT
Karyotype
Exclude congenital adrenal hyperplasia which carries a risk of adrenal crisis in 2 weeks of life.
What are the features of congenital hypothyroidism?
1 in 4000 births
Causes; athyreosis, hypo plastic, ectopic, dyshormonogenic.
New born screening
Must start treatment within 1st 2 weeks.
What are the features of acquired Hypothyroidism?
Hashimoto’s is most common cause.
Family history of thyroid/autoimmune disease
Childhood issues of lack of height gain, pubertal delay, poor school performance.
What are some assessments used to determine obesity?
Weight BMI (kg/m2) Height Waist circumference Skin folds History and examination Complications
What are the different forms of height?
A endogenous pathological
B lean normal
C exogenous
What height alongside obesity is abnormal?
Obese + short = abnormal
What are some complications of Obesity?
Metabolic syndrome Fatty liver disease Gallstones Reproductive dysfunction Nutritional deficiencies etc.
What are some causes of obesity?
Simple obesity Drugs Syndromes - learning difficulties Endocrine disorders - growth failure Hypothalamic damage - loss of appetite control
What are the key symptoms of type 1 diabetes?
Thirsty Thinner Tired Using the toilet more Return to bed wetting
Children under 5: Heavier than usual nappies Blurred vision Candidiasis Constipation Recurring skin infections Irritability Behavioural change
What test should you do immediately if suspect type 1 diabetes?
Finger prick capillary glucose test.
Diabetes if result > 11mmol/L
What are the symptoms of diabetic ketoacidosis?
Nausea and vomiting Abdominal pain Sweet smelling breath Drowsiness Rapid, deep sighing respiration Coma
