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Paediatrics > Endocrinology and Diabetes > Flashcards

Endocrinology and Diabetes Flashcards

1
Q

what is normal growth? (precise definition is difficult)

A
  • Wide range within healthy population
    – Different ethnic subgroups
    – Inequality in basic health and nutrition
    – Normality may relate to individuals or populations (genetic influence)
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2
Q

what factors influence height?

A 
Age
 Sex
 Race
 Nutrition
 Parental heights 
 Puberty
 Skeletal maturity (bone age)
 General health
 Chronic disease
 Specific growth disorders
 Socio-economic status
 Emotional well-being
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3
Q

what are the 3 key stages of normal growth?

A
  • infancy
  • childhood
  • pubertal
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4
Q

Describe the shape of a normal growth curve in terms of infancy, childhood and pubertal stages. (male and female)

A

Male
infancy - height gain decreases drastically
childhood - stable but slight decline
puberty - stable then massive increase then decline

female
- much the same as male but they go through puberty earlier and don’t have as large an increase in height as males

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5
Q

what are some measurement takes to assess a baby’s growth?

A
  • length
  • height
  • sitting height
  • head circumference
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6
Q

when would you do a head circumference and how do you do it?

A

routine in under 2s

tape around forehead and occipital prominence (maximal circumference)

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7
Q

how can you tell if the child is growing at the right rate?

A
  • growth charts and plotting

- MPH and Target centiles

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8
Q

what is used to measure bone age?

A

the tanner-whitehorse method (TW)

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9
Q

describe TW bone staging

A
  • radiographs must be of high quality
  • evaluation by skilled practitioner
    pathological conditions can distort bones
  • severe osteopenia confuses interpretation
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10
Q

what parts if the history and examination are required to make a diagnosis?

A
  • Birth weight and gestation
  • PMH
  • Family history/social history/schooling
  • Systematic enquiry
  • Dysmorphic features
  • Systemic examination including pubertal assessment
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11
Q

What assessment tools are used to determine growth percentiles etc

A
  • Height/ length/ weight
  • Growth Charts and plotting • MPH and Target centiles
  • Growth velocity
  • Bone age
  • Pubertal assessment
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12
Q

what are some indications for referral for growth disorders?

A
  • 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
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13
Q

what are some common causes of short stature?

A
  • Familial
  • Constitutional
  • SGA/IUGR
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14
Q

what are some pathological causes of short staure

A
  • Undernutrition
  • Chronic illness (JCA, IBD, Coeliac)
  • Iatrogenic (steroids)
  • Psychological and social
  • Hormonal (GHD, hypothyroidism)
  • Syndromes (Turner, P-W)
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15
Q

what investigations would you do to for working out the cause of short stature and why would you do them (looking for what?)?

A 
• FBC and ferretin
- general health, coeliac, chron's, JCA 
•U&E, LFT,Ca,CRP
- general health, renal and liver disease, disorders of Ca metabolism 
•Coeliac serology and IgA 
- coeliac disease 
•IGF-1, TFT, Prolactin, Cortisol, (gonadotrophins and sex hormones)
- hormonal disorders 
•karyotype 
- turner's syndrome
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16
Q

name a staging used for puberty

A

Tanner’s staging

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17
Q

describe tanner’s staging (what the stages are)

A
  • 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 eg statement as B3 PH3 or G2 PH2 6/6
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18
Q

describe tanner’s staging (info about it)

A
  • assessment by clinical examination
  • undertaken only with parental and child consent and with adequate privacy
  • requires considerable expertise
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19
Q

what is used to measure testicular maturation?

A

Prader orchidometer

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20
Q

what is the relationship between growth and other stages in puberty? (describe the curve and when things happen in puberty)

A

males
12 - onset of testicular growth (low height velocity)
13 - penile growth (height inc slightly in velocity)
14 - advanced changes of puberty (peak of height increase velocity)
16 - facial hair and shaving (decrease in height one velocity)

females
11 - breast budding (low heighten velocity)
12 - early breast development (peak of heigh inc velocity)
13- menarche (decline in height inc velocity)

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21
Q

describe early and delayed puberty in boys and girls

A 
Boys
– early < 9 years (rare)
– delayed >14 (common, especially CDGP)
• Girl
– early <8 years
– delayed >13 (rare)
22
Q

talk about constitutional delay of growth and puberty (CDGP)

A
  • Boys mainly
  • Family history in dad or brothers (difficult to obtain!)
  • Bone age delay
  • Need to exclude organic disease
23
Q

what are some other causes of delayed puberty?

A
  • 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)
24
Q

what is affected in early sexual development and what are they caused by?

A

breast development
- hypothalamic activation

secondary characteristics
- sex steroid hormone secretion

PV bleeding

25
Q

what conditions result in early breast development?

A
  • Infantile thelarche
  • Thelarche variant (premature thelarche)
  • Central precocious puberty
26
Q

what conditions result in early secondary sexual characteristics?

A
  • Exaggerated adrenarche

- Precocious pseudopuberty (i.e. Congenital adrenal hyperplasia)

27
Q

what conditions result in early PV bleeding?

A

Premature menarche

28
Q

talk about central preciosos puberty

A 
•Pubertal development
– Breast development in girls
– Testicular enlargement in boys
• Growth spurt
• Advanced bone age
• Need to exclude pituitary lesion---- MRI
29
Q

talk about precocious pseudo puberty

A
  • Abnormal sex steroid hormone secretion
  • Gonadotrophin independent (low/prepubertal levels of LH and FSH)
  • Clinical picture: secondary sexual characteristics
  • Need to exclude Congenital Adrenal Hyperplasia!
30
Q

what are the management approaches to ambiguous genitalia?

A

•Do not guess the sex of the baby!
• Multidisciplinary approach (paed endo, surg,
neonatologist, geneticist, psychologist)
• Exam: gonads?/ internal organs
• Karyotype
• Exclude Congenital Adrenal Hyperplasia!- risk of adrenal crisis is first 2 weeks of life

31
Q

what are some essentials of puberty?

A

•Pubertal staging:
– Breast budding (Tanner Stage B 2) in a girl
– Testicular enlargement (Tanner Stage G2 -T 3- 4 ml) in boy
• Pubertal tempo
• Normal pubertal age

32
Q

talk about congenital hypothyroidism

  • epidemiology
  • causes
  • screening etc
A 
•1 in 4000 births
• Causes:
– Athyreosis/ hypoplastic/ ectopic
– Dyshormonogenic
• Newbornscreening
• Start treatment within first 2 weeks
33
Q

talk about acquired hypothyroidism

  • most common cause
  • family history
  • childhood issues
A

•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)

34
Q

talk about obesity

A
  • Nearly a third (31%) of children aged 2–15 are overweight or obese1
  • The direct cost of obesity to the NHS is estimated to be £4.2bn a year2
  • At Reception and Year 6, children in the poorest decile are almost twice as likely to be obese compared those in the most affluent decile3
35
Q

what assessment need to be done for obesity?

A
  • Weight
  • Body mass index (BMI) (kg/m2) • Height
  • Waist circumference
  • Skin folds
  • History and examination
  • Complications
36
Q

heights (3 types)

A
  • endogenous pathological - short
  • lean normal
  • exogenous - tall
37
Q

what is abnormal in terms of hight and weight

A

obese and short

38
Q

important things to ask in the history in obesity?

A 
• Diet
• Physical activity • Family history
• Symptoms suggestive of           - Syndrome
– Hypothalamic- pituitary pathology
– Endocrinopathy 
– Diabetes
39
Q

what are complications of obesity?

A 
 Metabolic syndrome
 Fatty liver disease (nonalcoholic steatohepatitis)
 Gallstones
 Reproductive dysfunction (eg, PCOS)
 Nutritional deficiencies
 Thromboembolic disease
 Pancreatitis
 Central hypoventilation
 Obstructive sleep apnea
 Gastroesophageal reflux disease
 Orthopaedic problems (slipped capital femoral epiphysis, tibia vara)
 Stress incontinence
 Injuries
 Psychological
 Left ventricular hypertrophy
 Atherosclerotic cardiovascular disease
 Right-sided heart failure
40
Q

what are some causes for obesity?

A
  • SIMPLE OBESITY
  • Drugs
  • Syndromes
  • Endocrine disorders
  • Hypothalamic damage
41
Q

what is the relationship between intake and activity in obesity?

A

high intake and low activity

42
Q

treatment for obesity?

A
  • Diet
  • Exercise
  • Psychological input
  • Drugs???
43
Q

conclusions about obesity

A
  • Simple obesity is the most common cause

* Investigations are rarely necessary

44
Q

what is the

  • endocrine cause
  • syndromic cause
  • hypothalamic cause

of obesity?

A

endocrine –> growth failure

syndromes –> learning difficulties

hypothalamic –> loss of appetite control

45
Q

why is an early diagnosis important in type 1 diabetes?

A

Scotland has 5th highest incidence of Type 1 Diabetes in the world
…………………………………
In Scotland 300 children under the age of 15 years are diagnosed with Type 1 Diabetes annually
…………………………………
1 in 4 are diagnosed in DKA
Rising to 1 in 3 under the age of 5 years
…………………………………
In the UK 10 children die and 10 children suffer permanent neurological disability

46
Q

is delayed diagnosis of type 1 diabetes a problem?

A

Every Health Board in Scotland has young people present critically unwell with new onset diabetes and tragically several deaths have occurred in recent years
……………………………………………
The diagnosis has often not been contemplated or, even if diabetes is considered, inappropriate testing is performed or referral has been delayed
……………………………………………
DKA is preventable if diabetes is diagnosed early
……………………………………………
33% of children in DKA have had at least one medical related visit prior to diagnosis

47
Q

what are the three most important aspects in making an early diagnosis of type 1 diabetes?

A 
THINK – Symptoms
Thirsty
Thinner
Tired
Using the Toilet more .............................................
TEST- Immediately
Finger prick capillary glucose test
If result >11mmol/l .............................................
TELEPHONE – Urgently
Contact your local specialist team for a
same day review
48
Q

describe the THINK symptoms

A

Sometimes referred to as the 4T’s Thirsty
Tired
Thinner
Using the Toilet more
………………………………………………
A return to bedwetting or day-wetting in a previously dry child is a “red flag” symptom for diabetes
………………………………………………
In children under five also think: heavier than usual nappies
blurred vision
candidiasis (oral, vulval) constipation
recurring skin infections irritability, behaviour change

49
Q

what are symptoms of DKA?

A

Nausea & vomiting ……………………………………………………..
Abdominal pain ……………………………………………
Sweet smelling, “ketotic”
Breath ……………………………………………
Drowsiness ……………………………………………
Rapid, deep “sighing” respiration ……………………………………………
Coma

50
Q

how do you test immediately for DKA?

A

Finger prick capillary blood glucose test
Result >11mmol/l - Diabetes
Result <11mmol/l - Other cause
……………………………………
DO NOT request a returned urine specimen.
DO NOT arrange a fasting blood glucose test.
DO NOT arrange an Oral Glucose Tolerance Test.
DO NOT wait for lab results (urine or blood).

51
Q

what does the telephone part of management for DKA involve?

A

Call local specialist paediatric diabetes team for a same day review
…………………………………
Diabetic Ketoacidosis (DKA) can occur very quickly in children.
…………………………………
If in any doubt about a diagnosis of Type 1 Diabetes call for advice
…………………………………
Don’t delay the diagnosis

Paediatrics (13 decks)

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