Endocrinology and growth Flashcards
What are the three phases of normal growth and puberty?
Infantile phase
Childhood
Puberty
At what age does the childhood phase begin and end?
from 2 years until adolescent growth spurt
When is the average peak of growth spurt in girls?
12
When is the average peak of growth spurt in boys?
14
Which phase is thyroxine and GH dependent?
Childhood phase (infantile phase is non dependent on these)
Which hormone stimulates growth hormone?
Oestrogen (Aromatised from testosterone)
Does oestrogen stimulate GH in both sexes?
yes!!
Which hormone stimulates the fusion of epiphyses?
oestrogen
List three causes of short stature
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)
How can causes of failure to thrive/weight faltering be divided?
organic and non-organic
Name a non-organic cause of failure to thrive
nutritional, pyschological
Name two causes of weight faltering
malabsorption (coeliac disease)
cardiac
resp
renal insufficiencies
What is the cause of growth failure?
GH deficiency
Early puberty is most commonly associated with which sex?
females
Delayed puberty is most commonly associated with which sex?
males
Which tumour can cause GH deficiency?
craniopharyngioma
Name a syndrome that causes delayed puberty
Kallman’s syndrome
Name one cause of primary ovarian failure
Turner’s and total body irradiation (prior to bone marrow transplant for leukaemia)
Name two causes of primary testicular failure?
klinefelter’s syndrome, after TB infection, following surgery for cryptorchidism (undescended testes)
What are the levels of FSH and LH in primary gonadal failure?
elevated
What is the most common cause of hyperthyroidism in childhood and adolescence?
grave’s disease
Is grave’s disease more common in children or adults?
rare in children however more severe
Name one congenital cause of hypothyroisidm?
thyroid dysgenesis
Name one acquired cause of hypothyroidism?
hashimoto’s thyroiditis
What is the most common cause of acquired central insufficiency?
exogenous steroids
Name four hormones synthesized in the anterior pituitary
LH, FSH TSH ACTH GH Prolactin
List two hormones stored by the posterior pituitary gland
ADH and oxytocin
produced in the hypothalamus but stored in pituitary
Name three axis in endocrine system
thyroid, gonadal, growth hormone,adrenal, and posterior pituitary axis
What is the most common cause of polyuria and polydipsia in preschool children?
habit drinking
What is the cause of congenital diabetes insipidus?
deficient ADH
What is a cause of acquired diabetes insipidus?
tumour- craniopharygioma
Name autoimmune cause of poor growth?
hypothyroidism
What is the effect of deficiency in T4 on growth and puberty?
stunts growth but doesn’t delay puberty
Two investigations in patient with poor growth?
thyroxine test hand XR (growth potential)
Aside from height and weight, what else is important to plot?
mid-parental height
Is BMI stable in children?
no
What is the first sign of puberty in girls and boys?
breast enlargement Testicular changes (if GP patient says child is more sweaty and has acne, this does not indicate puberty)
Which investigation must always be conducted in girls if concern for short stature?
karyotype- Turner’s syndrome= cause of short stature
What is Tanner staging?
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
List three factors that influence childhood growth
Fetal- uterine environment
Infant- nutrition and thyroid hormones
Childhood- GH and thyroid hormone
Pubertal- testosterone and oestrogen
Baby is born premature at 34 weeks. What is the gestational correction?
40-34= 6 weeks
For how long do you continue to use the corrected gestational age on growth charts?
32-36 weeks for 1 year
<32 weeks for 2 years
What is the normal weight loss in newborns?
<10% in the first 3-4 days
At what point should newborn regain birthweight?
by 3 weeks
Why do babies lose weight when they are born?
water loss
How is faltering weight defined
2 or more centile spaces and birthweight between 9th and 91st centiles
List three differential diagnoses for faltering weight
- Poor oral intake- (cleft palate, poor suck, CNS disorder)
- Malabsorption (CF, IBD)
- Increased metabolic state (cardiac failure, hyperthryoidism, malignancy, renal failure)
- Metabolic diseases
- Prenatal- maternal nutrition, smoking, toxins
- Non-organic: food aversion, family mental health, neglect…
List three investigations for faltering weight
FBC, U+Es, CRP, anti-TTG (>9 months), TFT, ferritin, iron studies, urine MC&S
weight, height, OFHC
Feeding history
full developmental/clinical assessment
Three differential diagnoses for macrocephaly?
Hydrocephalus Raised intracranial blood volume Megancephaly Thickening of skull Mass lesions
What causes hydrocephalus?
increased CSF
What can cause increased intracranial blood volume?
haemorrhage
arteriovenous malformation
What can causes megancephaly?
=enlargement of brain parenchyma
NF1
What can cause thickening of the skull?
bone marrow hyperplasia e.g. thalassemia major
primary bone disorders
List two mass lesions that can cause macrocephaly?
intracranial cyst
tumour
abscess
