Endocrinology and growth

Question 1

What are the three phases of normal growth and puberty?

Answer 1

Infantile phase
Childhood
Puberty

Question 2

At what age does the childhood phase begin and end?

Answer 2

from 2 years until adolescent growth spurt

Question 3

When is the average peak of growth spurt in girls?

Answer 3

12

Question 4

When is the average peak of growth spurt in boys?

Answer 4

14

Question 5

Which phase is thyroxine and GH dependent?

Answer 5

Childhood phase (infantile phase is non dependent on these)

Question 6

Which hormone stimulates growth hormone?

Answer 6

Oestrogen (Aromatised from testosterone)

Question 7

Does oestrogen stimulate GH in both sexes?

Answer 7

yes!!

Question 8

Which hormone stimulates the fusion of epiphyses?

Answer 8

oestrogen

Question 9

List three causes of short stature

Answer 9

NIDSCED
Normal genetic short stature
Intrauterine growth retardation (alcohol)
Dysmorphic syndrome (down’s, turner’s)
Skeletal dysplasias- achondroplasia
Chronic systemic disease (IBD, CF, sever asthma, CKD)
Endocrine disorder
Dire social circumstances (psycholoigcal)
+Constitutional delay (looks young and short for age)

Question 10

How can causes of failure to thrive/weight faltering be divided?

Answer 10

organic and non-organic

Question 11

Name a non-organic cause of failure to thrive

Answer 11

nutritional, pyschological

Question 12

Name two causes of weight faltering

Answer 12

malabsorption (coeliac disease)
cardiac
resp
renal insufficiencies

Question 13

What is the cause of growth failure?

Answer 13

GH deficiency

Question 14

Early puberty is most commonly associated with which sex?

Answer 14

females

Question 15

Delayed puberty is most commonly associated with which sex?

Answer 15

males

Question 16

Which tumour can cause GH deficiency?

Answer 16

craniopharyngioma

Question 17

Name a syndrome that causes delayed puberty

Answer 17

Kallman’s syndrome

Question 18

Name one cause of primary ovarian failure

Answer 18

Turner’s and total body irradiation (prior to bone marrow transplant for leukaemia)

Question 19

Name two causes of primary testicular failure?

Answer 19

klinefelter’s syndrome, after TB infection, following surgery for cryptorchidism (undescended testes)

Question 20

What are the levels of FSH and LH in primary gonadal failure?

Answer 20

elevated

Question 21

What is the most common cause of hyperthyroidism in childhood and adolescence?

Answer 21

grave’s disease

Question 22

Is grave’s disease more common in children or adults?

Answer 22

rare in children however more severe

Question 23

Name one congenital cause of hypothyroisidm?

Answer 23

thyroid dysgenesis

Question 24

Name one acquired cause of hypothyroidism?

Answer 24

hashimoto’s thyroiditis

Question 25

What is the most common cause of acquired central insufficiency?

Answer 25

exogenous steroids

Question 26

Name four hormones synthesized in the anterior pituitary

Answer 26

``` LH, FSH TSH ACTH GH Prolactin ```

Question 27

List two hormones stored by the posterior pituitary gland

Answer 27

ADH and oxytocin | produced in the hypothalamus but stored in pituitary

Question 28

Name three axis in endocrine system

Answer 28

thyroid, gonadal, growth hormone,adrenal, and posterior pituitary axis

Question 29

What is the most common cause of polyuria and polydipsia in preschool children?

Answer 29

habit drinking

Question 30

What is the cause of congenital diabetes insipidus?

Answer 30

deficient ADH

Question 31

What is a cause of acquired diabetes insipidus?

Answer 31

tumour- craniopharygioma

Question 32

Name autoimmune cause of poor growth?

Answer 32

hypothyroidism

Question 33

What is the effect of deficiency in T4 on growth and puberty?

Answer 33

stunts growth but doesn't delay puberty

Question 34

Two investigations in patient with poor growth?

Answer 34

``` thyroxine test hand XR (growth potential) ```

Question 35

Aside from height and weight, what else is important to plot?

Answer 35

mid-parental height

Question 36

Is BMI stable in children?

Answer 36

no

Question 37

What is the first sign of puberty in girls and boys?

Answer 37

``` breast enlargement Testicular changes (if GP patient says child is more sweaty and has acne, this does not indicate puberty) ```

Question 38

Which investigation must always be conducted in girls if concern for short stature?

Answer 38

karyotype- Turner's syndrome= cause of short stature

Question 39

What is Tanner staging?

Answer 39

scale of physical development in children, adolescents and adults. The scale defines physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitals, testicular volume and development of pubic hair

Question 40

List three factors that influence childhood growth

Answer 40

Fetal- uterine environment Infant- nutrition and thyroid hormones Childhood- GH and thyroid hormone Pubertal- testosterone and oestrogen

Question 41

Baby is born premature at 34 weeks. What is the gestational correction?

Answer 41

40-34= 6 weeks

Question 42

For how long do you continue to use the corrected gestational age on growth charts?

Answer 42

32-36 weeks for 1 year | <32 weeks for 2 years

Question 43

What is the normal weight loss in newborns?

Answer 43

<10% in the first 3-4 days

Question 44

At what point should newborn regain birthweight?

Answer 44

by 3 weeks

Question 45

Why do babies lose weight when they are born?

Answer 45

water loss

Question 46

How is faltering weight defined

Answer 46

2 or more centile spaces and birthweight between 9th and 91st centiles

Question 47

List three differential diagnoses for faltering weight

Answer 47

1. Poor oral intake- (cleft palate, poor suck, CNS disorder) 2. Malabsorption (CF, IBD) 3. Increased metabolic state (cardiac failure, hyperthryoidism, malignancy, renal failure) 4. Metabolic diseases 5. Prenatal- maternal nutrition, smoking, toxins 6. Non-organic: food aversion, family mental health, neglect...

Question 48

List three investigations for faltering weight

Answer 48

FBC, U+Es, CRP, anti-TTG (>9 months), TFT, ferritin, iron studies, urine MC&S weight, height, OFHC Feeding history full developmental/clinical assessment

Question 49

Three differential diagnoses for macrocephaly?

Answer 49

``` Hydrocephalus Raised intracranial blood volume Megancephaly Thickening of skull Mass lesions ```

Question 50

What causes hydrocephalus?

Answer 50

increased CSF

Question 51

What can cause increased intracranial blood volume?

Answer 51

haemorrhage | arteriovenous malformation

Question 52

What can causes megancephaly?

Answer 52

=enlargement of brain parenchyma NF1

Question 53

What can cause thickening of the skull?

Answer 53

bone marrow hyperplasia e.g. thalassemia major | primary bone disorders

Question 54

List two mass lesions that can cause macrocephaly?

Answer 54

intracranial cyst tumour abscess