Growth and Development And Endocrine Problems in Childhood Flashcards
What would be measured when assessing normal growth in children?
Height
Length
Sitting Height
Head circumference
What staging Is used for the staging of puberty?
Tanner
What is involved in the Tanner staging of puberty?
B 1 - 5 = breast development G 1-5 = genital development PH 1-5 = pubic hair AH 1-3 = axillary hair T 2ml - 20ml
What is used to assess testicular maturation?
Prader Orchidometer
Factors influencing height
Age Sex Race Nutrition Parental heights Puberty Skeletal maturity (bone age) General health Chronic disease Specific growth disorders Socio-economic status Emotional well being
What in the tanner staging shows the earliest objective signs of puberty?
Breast budding - tanner stage 2 in a girl
Testicular enlargement - tanner stage T 3-4ml in a boy
Indications for referral for a growth disorder
Extreme tall or short stature (off centiles)
Height below target height
Abnormal height velocity (crossing centiles)
History of chronic disease
Obvious dysmorphic syndrome
Early/late puberty
Pathological causes of short stature
Undernutrition Chronic illness (JCA, IBD, coeliac) Iatrogenic (steroids) Psychological and social Hormonal (GHD, hypothyrodisim) Syndromes e.g. PW, Turners, noonans
Whats classified as early puberty in boys and how common is this?
< 9 years old
Rare
Whats classified as delayed puberty in boys and how common is this?
> 14 y/o
Common, especially CDGP
Whats classified as early puberty in girls?
< 8 years
Whats classified as delayed puberty in girls and how common is this?
> 13 years (rare)
Who is constitutional delay of growth and puberty (CDGP) seen in mainly and what is common with it?
Boys mainly
FH in dads or brothers (difficult to obtain)
Bone age delay
Causes of delayed puberty
CDGP
Gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
Chronic disease (chrons, asthma)
Impaired HPG axis (e.g. kallmans syndrome)
Peripheral (e.g. cryptorchidism, testicular irridation)
Treatment of central precocious puberty
GnRH agonist
Presentation of precocious pseudopuberty
Secondary sexual characteristics
When should treatment be started with congenital hypothyroidism?
Within first 2 weeks
What is the most common cause of acquired hypothyroidism ?
Autoimmune (Hashimoto’s) thyroiditis
Childhood issues who have acquired hypothyroidism
Lack of height gain
Pubertal delay (or precocity)
Poor school performance (but work steadily)
What BMI centile is classed as overweight?
BMI >85th centile
What BMI centile is classified as obese?
BMI > 97.5th centile
Complications of obesity in children
Metabolic syndrome Fatty liver disease (non alcoholic steatohepatitis) Gallstones Reproductive dysfunction (e.g. PCOS) Nutritional deficiencies Thromboembolic disease Pancreatitis Central hypoventilation Obstructive sleep apnoea 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
Drugs that cause obesity
Insulin
Steriods
Antithyroid drugs
Sodium valproate
Syndromes that cause obesity
Prader willi syndrome
Pseudohypoparathyroidsm type 1
Downs syndrome
Endocrine disorders that cause obesity
Hypothyroidism GH definciency Hypothalamic lesion (tumour/trauma/infection) Androgen excess Insulinoma Insulin resistance syndromes Leptin deficiency
The 4 Ts of symptoms of diabetes in children
Thirsty
Thinner
Tired
using the Toilet more
If you suspect diabetes mellitus in a child, what test would you do?
Finger prick capillary glucose test
What would indicate DM in a child after a finger prick capillary glucose test?
> 11 mmol/l
What is a RED FLAG symptom for diabetes in children?
Return to bedwetting or day wetting in a previously dry child
Symptoms of diabetes in children < 5 y/o
Heavier than usual nappies Blurred vision Candidiasis (oral, vulval) Constipation Recurring skin infections Irritability, behaviour change
Symptoms of diabetic ketoacidosis
Nausea and vomiting Abdominal pain Sweet smelling, "ketotic breath" Drowsiness Rapid, deep "sighing" respiration Coma
