endocrine and diabetes Flashcards
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
assessment tools for child development
- height/ length/ weight
- growth charts and plotting
- MPH and target centiles
- growth velocity
- bone age
- pubertal assessment
growth disorders - indications for referral
- extreme short or tall stature
- height below target height
- abnormal height velocity
- history of chronic disease
- obvious dysmorphic syndrome
- early/ late puberty
pathological causes of short stature
- undernutrition
- chronic illness (JCA, IBD, coeliac)
- iatrogenic (steroids)
- psychological and social
- hormonal (GHD, hypothyroidism)
- syndromes (turners)
investigations into short stature
- FBC and ferritin
- U&E, LFT, Ca, CRP
- coeliac serology and IgA
- IGF-1, TFT, prolactin, cortisol
- karyotype
coeliac investigations paeds
- FBC
- ferritin
- coeliac serology
- IgA
what factors are included in Tanner method of staging puberty - female
- breast development
- genital development
- pubic hair
- axillary hair
define early puberty boys
<9
define delayed puberty boys
> 14
define early puberty girls
<8
define delayed puberty girls
> 13
Constitutional delay of growth and puberty
temporary delay in the skeletal growth and thus height of a child with no physical abnormalities causing the delay
causes of early breast development (hypothalamic activation)
- infantile thelarche
- thelarche varient
- central precocious puberty
causes of early secondary sexual characteristics
- exaggerated adrenarche
- precocious pseudopuberty (e.g. congenital adrenal hyperplasia)
causes of precocious pseudopuberty
- abnormal sex steroid hormone secretion
- gonadotrophin indépendant
need to exclude congenital adrenal hyperplasia
management approach for ambiguous genitalia
DO NOT GUESS SEX OF BABY
- MDT approach
- exam of gonads and internal organs
- karyotype
- exclude congenital adrenal hyperplasia
affect of congenital hypothyroidism
- athyreosis/ hypoplastic ectopic
- dyshormonogenic
presentation of acquired hypothyroidism in children (most commonly hashimotos)
- FH of thyroid/ autoimmune disorders
- lack of height gain
- pubertal delay
- poor school performance (but work steadily)
obese + short =
abnormal
history takin in obese child
- diet
- physical activity
- family history
symptoms suggestive of: - hypothalamic-pituitary pathology
- endocrinopathy
- diabetes
causes of obesity
- simple obesity
- drugs
- syndromes
- endocrine disorders
- hypothalamic damage
indicator of endocrine cause of obesity
growth failure
indicator syndrome cause of obesity
learning difficulties
indicator hypothalamic causes of obesity
loss of appetite control
symptoms of paediatric diabetes
- thirsty
- thinner
- tired
- increased toilet usage
- return to wetting bed
if diabetes suspected, what should be done immediately?
- finger prick capillary glucose test
if result >11mmol/l: - contact local specialist team for a same day review
symptoms of diabetes in children under 5
- heavier than usual nappies
- blurred vision
- candidiasis
- constipation
- recurring skin infections
- irritability, behaviour changes
DKA symptoms
- N+V
- abdo pain
- ketotic breath
- drowsiness
- rapid, deep ‘sighing’ respiration
- coma
what should you not do when a child presents with suspected diabetes
- nothing
- request returned urine specimen
- arrange fasting blood glucose test
- arrange oral glucose tolerance test
- wait for lab results
