Growth and Development

Question 1

what are factors influencing height?

Answer 1

age
sex
race
nutrition
parental heights
puberty
skeletal maturity
general health
chronic disease
specific growth disorders
socio-economic status

Question 2

what are the most important pubertal stages?

Answer 2

Breast budding (Tanner Stage B 2) in a girl •
Testicular enlargement (Tanner Stage G2
-T 3- 4 ml) in boy
• these are the earliest objective signs of puberty
• and when present puberty will usually progress onwards

Question 3

what are indications for referral if there are suspected growth disorders?

Answer 3

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

Question 4

what are common causes of short stature?

Answer 4

familial
constitutional
SGA/IUGR

Question 5

what are the pathological causes of short stature

Answer 5

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

Question 6

what are early and delayed puberty?

Answer 6

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

Question 7

what are some causes of delayed puberty

Answer 7

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

Question 8

what is Central Precocious Puberty

Answer 8

early 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 tumor?

Question 9

what is the treatment for Central Precocious Puberty

Answer 9

– GnRH agonist

Question 10

what is Precocious Pseudopuberty

Answer 10

Gonadotrophin independent (low/prepubertal levels of LH and FSH)
• Abnormal sex steroid hormone secretion
• Virilasing or feminasing
• Clinical picture: secondary sexual characteristics

Question 11

indications of Precocious Pseudopuberty in boys and girls

Answer 11

Girls
– usually early developers
– watch rapid progression/growth acceleration
• Boys
– usually late developers
• Beware abnormal patterns of pubertal development

Question 12

what are the causes of congenital hypothyroidism?

Answer 12

Athyreosis/ hypoplastic/ ectopic

– Dyshormonogenic

Question 13

investigations of Congenital hypothyroidism

Answer 13

Newbornscreening

Question 14

what is the common cause of acquired hypothyroidism?

Answer 14

Autoimmune (Hashimoto’s) thyroiditis

Family history of thyroid/ autoimmune disorders

Question 15

how does acquired hypothyroidism effect childhood issues?

Answer 15

Lack of height gain
– Pubertal delay (or precocity)
– Poor school performance (but work steadily)

Question 16

what are causes of a high BMI?

Answer 16

SIMPLE OBESITY
• Drugs
• Syndromes
• Endocrine disorders
• Hypothalamic damage

Question 17

what are some endocrine disorders?

Answer 17

Hypothyroidism
 Growth hormone deficiency
 Glucocorticoid excess
 Hypothalamic lesion (tumour/trauma/infection)
 Androgen excess
 Insulinoma
 Insulin resistance syndromes
 Leptin deficiency

Question 18

symptoms of childhood diabetes tupe 1?

Answer 18

Thirsty
Tired
Thinner
Using the Toilet more

Question 19

what are diabetic ketoacidosis symptoms?

Answer 19

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

Question 20

what number of capillary blood glucose level would confirm diabetes?

Answer 20

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