Endocrine Problems in Childhood Flashcards
Discuss the identification and management of hypothyroidism in the newborn.
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Name common non-pathological causes of short stature.
- Familial
- Constitutional
- SGA/IUGR
Name pathological causes of short stature.
- Undernutrition
- Chronic illness (JCA, IBD, Coeliac)
- Iatrogenic (steroids)
- Psychological and social
- Hormonal (GHD, hypothyroidism)
- Syndromes (Turner, P-W)
Define early and delayed puberty for both males and females.
Males;
- Early <9 (rare)
- Delayed >14 (common, especially CDGP)
Females;
- Early <8 years
- Delayed >13 (rare)
Main points in Constitutional delay of growth and development (CDGP).
- Mainly males
- Family history in father or brother(s) (difficult to obtain)
- Due to bone age delay
- Need to exclude organic disease
Name other causes of delayed puberty.
- Gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
- Chronic disease (Crohn’s, asthma)
- Impaired HPG axis (septo-optic dysplasia, craniopharyngioma, Kallman’s syndrome)
- Peripheral (cryptorchidism, testicular irradiation)
Name the conditions of early sexual development.
Breast development;
- Infantile thelarche
- Thelarche variant (premature thelarche)
- True central precocious puberty
Secondary sexual characteristics;
- exaggerate adrenarche
- Precocious pseudo puberty
PV bleeding;
- Premature menarche
Main points of central precocious puberty.
- Growth spurt
- Advanced bone age
Girls;
- Breast development
- Usually idiopathic
- Pituitary imaging
Boys;
- Testicular enlargement
- Look for underlying cause (?brain tumour)
Treatment: GnRH agonist
Main points of precious pseudopuberty.
- Gonadotrophin independent (low/prepubertal levels of LH and FSH)
- Abnormal sex steroid hormone secretion
- Virilasing or feminasing
- Clinical picture: secondary sexual characteristics
Describe the management approach to ambiguous genitalia.
- Do not guess the sex of the baby!
- MDT approach (paed endo, surg, neonatologist, geneticist, psychologist)
- Examine gonads?/ internal organs
- Karyotype
- Exclude congenital adrenal hyperplasia! - risk of adrenal crisis is first 2 weeks of life
Summarise congenital hypothyroidism.
- 1 in 4000 births
- Causes: athyreosis/hypoplastic/ectopic
- Dyshormonogenic
- Newborn screening
- Start treatment within first 2 weeks
Summarise acquired hypothyroidism.
- 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 works steadily)
Describe the assessment of obesity.
- Weight
- BMI = kg/m2
- Height
- Waist circumference
- Skin folds
- History and examination
- Complications
Names causes of obesity.
- SIMPLE OBESITY
- Hypothalamic damage
Syndromes;
- Prader Willi syndrome
- Laurence-Moon-Biedl syndrome
- Pseudohypoparathyroidism type 1
- Down’s syndrome
Drugs;
- Insulin
- Steroids
- Antithyroid drugs
- Sodium valproate
Endocrine disorders;
- Hypothyroidism
- Growth hormone deficiency
- Glucocorticoid excess
- Hypothalamic lesion (tumour/trauma/infection)
- Androgen excess
- Insulinoma
- Insulin resistance syndromes
- Leptin deficiency
