Endocrine and Diabetes

Question 1

What tools can be used to assess growth and development of children?

Answer 1

• Height/ length/ weight
• Growth Charts and plotting
• MPH and Target centiles
• Growth velocity
• Bone age
• Pubertal assessment

Question 2

Describe the indications for referring a child for investigation for a growth disorder

Answer 2

• 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

Question 3

When do you change from assessing growth by measuring length to measuring height of a child?

Answer 3

Age 2 years

Question 4

What corrections must be made when calculating mid-parental height

Answer 4

Correct for gender; add/subtract 15cm to/from mum/dad’s height

Question 5

What is the relevance of bone age when assessing a child’s growth?

Answer 5

Bone age estimates the growth potential o the child

• advanced bone age means reduced growth potential
• immature bone age means that there is lots of potential and therefore the child is not growing as much as they should be

Question 6

How is testicular volume measured?

Answer 6

Prader Orchidometer

Question 7

At what testicular volume does the growth spurt occur?

Answer 7

8 - 10ml

Question 8

At what ages is puberty early / delayed?

Answer 8

Boys

• early puberty < 9 years
• delayed puberty > 14 years

Girls

• early puberty < 8 years
• delayed puberty > 13 years

Question 9

Describe the features of CDGP

Answer 9

Constitutional delay of growth and puberty

• positive FH
• bone age delay

(need to exclude organic disease)

Question 10

List the causes of delayed puberty

Answer 10

Constitutional delay (CDGP)
Gonadal dysgenesis (Turner, Klinefelter syndromes)
Chronic disease (Crohn’s, asthma)
Impaired HPG axis (Kallman’s syndrome)
Peripheral (cryptorchidism, testicular irradiation)

Question 11

Give two causes of early sexual development

Answer 11

Central precocious puberty

Precocious pseudopuberty

Question 12

What condition must be excluded in patients with central precocious puberty?

Answer 12

Pituitary lesions (MRI scan)

Question 13

What condition must be excluded in patients with precocious pseudopuberty

Answer 13

Congenital adrenal hyperplasia

- adrenal crisis in first two weeks if untreated

Question 14

What is the difference between central precocious puberty and precocious pseudopuberty?

Answer 14

Central: early pubertal development (breasts/testes)
Pseudopuberty: early development of secondary sex characteristics

Question 15

Describe the pathological causes of short stature

Answer 15

Undernutrition
Chronic illness (JCA, IBD, Coeliac)
Iatrogenic (steroids)
Psychological and social
Hormonal (GHD, hypothyroidism)
Syndromes (Turner, P-W)

Question 16

How is growth hormone deficiency diagnosed?

Answer 16

Initial finding of low IGF-1

Growth-hormone stimulation test

Question 17

What are the clinical features of paediatric hypothyroidism?

Answer 17

Short and heavy
Pubertal delay
Poor school performance

Question 18

How is congenital hypothyroidism usually diagnosed?

Answer 18

Should be detected on newborn screening (heelprick test) and treated immediately to reduce risk of mental retardation

Question 19

Give three syndromes which affect growth

Answer 19

Turner’s syndrome
Noonan’s syndrome
Prada-WIlli syndrome
Marfan’s syndrome

Question 20

How might diabetes present in children younger than age 5?

Answer 20

o	heavier than usual nappies
o	blurred vision
o	candidiasis (oral, vulval) 
o	constipation
o	recurring skin infections
o	irritability, behaviour change

Question 21

How is diabetes diagnosed?

Answer 21

Glucose > 11 mmol/l on finger prick capillary glucose test

Question 22

What is the normal range for blood glucose level?

Answer 22

4 - 7mmol/l

Question 23

What are the symptoms of diabetic ketoacidosis?

Answer 23

• Nausea and vomiting
• Abdominal pain
• Sweet smelling, ketotic breath
• Drowsiness
• Rapid, deep “sighing” respiration
• Coma