Endocrine problems in childhood Flashcards
Explain hypothyroidism in newborns including the identification ond managment
• 1 in 4000 births • Causes - Athethyrosis/ hypoplastic/ ectopic - Dyshormonogenic • Newborn screening • Start treatment within the first 2 weeks (prevents developmental disorders later in life)
Explain hypopituitarism in adult and children
• Most common cause: autoimmune (Hashimoto’s) thyroiditis
• Family history of thyroid/ autoimmune disorders
• Childhood issues
- Lack of height gain
- Pubertal delay (or precocity)
- Poor school performance (but work steadily)
With regards to height what are the indications for referral?
- 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 the pathological causes of short stature?
- Undernutrition
- Chronic illness (JCA, IBD, coeliac disease)
- Iatrogenic (steroids)
- Psychological and social
○ children don’t grow in their home environment but as soon as they go into care they grow very quickly - Hormonal
○ Growth hormone deficiency
○ Thyroid deficiency: when presenting with hypothyroidism they are short and heavy but once they are treated the height goes up and the weight goes down - Syndromes
○ Turner’s syndrome
○ Prader-Willi syndrome
○ Noonan’s syndrome
○ Achondroplasia
What are the effects of obesity on growth?
- Obesity makes children taller
- It is abnormal if you have an obese and short child (that is the point you should be concerned)
- Obese individuals go through puberty earlier and so the normal individual is about the same height once they have stopped growing
What are the complications of obesity?
- Metabolic syndrome
- Fatty liver disease
- Gallstones
- Reproductive dysfunction
- Notational deficiencies
- Thromboembolic disease
- Pancreatitis
- Central hypoventilation
- Obstructive sleep apnoea
- Gastroesophageal reflux disease
- Orthopaedic problems
- Stress incontinence
- Injuries
- Phycological
- Left ventricular hypertrophy
- Atherosclerotic cardiovascular disease
- Right-sided heart failure
What are the causes of obesity?
- Simple obesity
- Drugs
○ Insulin
○ Steroids
○ Antithyroid drugs
○ Sodium valproate - Syndromes
○ Prader Willi syndrome
○ Laurence- Moon-Biedl syndrome
○ Pseudohypoparathyroidism type 1
○ Down’s syndrome - Endocrine disorders
○ Hypothyroidism
○ Growth hormone deficiency
○ Glucocorticoid excess
○ Hypothalamic lesion (trauma/ tumour/ infection)
○ Androgen excess
○ Insulinoma
○ Insulin resistance syndromes
○ Leptin deficiency - Hypothalamic damage
What is the treatment for obesity?
- Diet
- Exercise
- Physiological input
- Drugs???
○ There are drugs for obesity but not really for children
What are the ages of early and delayed puberty in girls and boys?
- Girls ○ Early < 8 years ○ Delayed > 13 (rare) - Boys ○ Early < 9 years (rare) ○ Delayed > 14 (common, especially CDGP)
Explain constitutional delay of growth and puberty (CDGP)
- Mainly boys
- Family history
- Bone age delay
- Need to exclude organic disease
What are the causes (other than CDGP) of delayed puberty?
- Gonadal dysgenesis ○ Turner 45X ○ Klinefelter 57XXY - Chronic disease ○ Crohn's ○ Asthma - Impaired HPG axis ○ Septo-optic dysplasia ○ Craniopharyngioma ○ Kallman's syndrome - Peripheral ○ Cryptorchidism ○ Testicular irradiation
Explain central precocious puberty
- Pubertal development
- Breast development in girls
- Testicular enlargement in boys
• Growth spurt
• Advanced bone age
• Girls - Usually idiopathic
- Pituitary imaging
• Boys - Look for underlying cause i.e. brain tumour
• Treatment: GnRH agonist
Explain precocious pseudopuberty
- Gonadotropin independent (low/ prepubertal levels of LH and FSH)
- Abnormal sex steroid hormone secretion
- Virilasing or feminasing
- Clinical picture: Secondary sexual characteristics
