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Year 2 - Endocrine > Growth and development + paediatric endocrine problems > Flashcards

Growth and development + paediatric endocrine problems Flashcards

1
Q

Measurements to assess growth

A

Height

Length (i.e. measuring them lying down) - from 0-2yrs

Sitting height - measuring this then subtracting from total height); done in people with unusual body proportions between top and bottom half

Head circumference

Weight

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2
Q

How is the potential height of a child calculated from their parents

A

By obtaining the mid-parental height

  • if male, add together the father’s and the mother’s height, divide this by two then add 7cm to the total (still normal if +/- 10cm)
  • if female, add together the father’s and the mother’s height, divide this by two then subtract 7cm from the total (Still normal if +/-8.5cm)
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3
Q

What is bone age an indicator of

A

Skeletal maturation: how much growth has taken place and how much there is left.

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4
Q

Name the method that’s used to stage puberty

+ describe the stages (5)

A

TANNER METHOD

  • Breast development (stage 1-5) (females only)
  • Genital development (stage 1-5) (males only)
  • Pubic hair (stage 1-5)
  • Axillary hair (stage 1-3)
  • Testicular volume (2-20ml)
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5
Q

Reasons for delayed bone age (4)

A

Constitutional delay of growth
Growth hormone deficiency
Hypothyroidism
Malnutrition/chronic illness

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6
Q

Reasons for advanced bone age (6)

A 
Tall stature
Premature adrenarche 
Overweight
Early puberty
Congenital Adrenal Hyperplasia
Overgrowth syndromes
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7
Q

Name 2 normal variations of growth

A

Familial short stature (FSS)
-associated with normal skeletal maturation

Constitutional growth delay (CGD)
-delayed bone age but eventually will catch up

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8
Q

Be aware of the main patterns of growth disorders

A

Short and thin
Short and fat,
Short and dysmorphic

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9
Q

Prepubertal sizes of testicles are estimated to be of what testicular volume

Pubertal sizes of testicles are estimated to be of what testicular volume

Adult sizes of testicles are estimated to be of what testicular volume

A

Prepubertal sizes - 1–3 ml,

pubertal sizes - 4 ml and up

adult sizes - 12-25ml

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10
Q

Know the history and examination features to be identified when assessing growth disorders

A

Birth weight
PMH/ FH/ SH
Growth charts

Examination:
Dysmorphic features
Current height/weight
Bone age
Pubertal assessment
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11
Q

Define normal growth

A

progression of changes in height, weight, and head circumference that are compatible with established standards for a given population

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12
Q

Factors influencing height (7)

A 
Age
Sex
Race
Nutrition
Parental height
Puberty
Growth disorder
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13
Q

Growth is driven by what in infantile years of life (0-2)

+ is growth rapid or not in this 2 years

A

NUTRITION, not growth hormone

rapid growth

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14
Q

Growth in childhood years (2-12) is largely driven by what hormones
+ is growth rapid or not in these childhood years

A

Growth hormone
Thyroxine

Not as rapid growth as infantile years

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15
Q

Growth in pubertal years of life (12+) is largely driven by what

A

Sex steroids that cause an increase in growth hormone secretion:

  • testosterone in boys
  • oestrogen in girls
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16
Q

Growth acceleration is limited towards the end of puberty by what

A

fusion of the epiphyseal plates (due to oestrogen in both sexes)

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17
Q

Do males/females grow faster at start of puberty

A

Females

Males grow fastest in mid-puberty

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18
Q

What is menarche + around what age does it start

A

Start of menstruation, i.e. first period

13

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19
Q

Tanner pubertal stage indicating start of puberty

  • males (2)
  • females
To help:
TANNER METHOD
-Breast development (stage 1-5) (females)
-Genital development (stage 1-5) (males)
-Pubic hair (stage 1-5)
-Axillary hair (stage 1-3)
-Testicular volume (2-20ml)
A

Males - G2 (scrotum and testes begin to enlarge) and T3-4ml

Females - B2 (breast budding)

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20
Q

Men end up taller than women by around 12.5cm because of what 3 factors

A

Pubertal growth spurt starts 2 years later than in girls (14 yr compared to 12 yr)

Pubertal growth spurt is more intense in boys

Boys are slightly bigger than girls during childhood

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21
Q

Pubertal growth spurt age in

  • males
  • females
A

14 (12-16)

12 (10-14)
-EARLIER in females

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22
Q

Effect of obesity on childhood growth

A

Usually taller than those the same age

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23
Q

Non-pathological causes of short stature (3)

A

Familial

Constitutional delay - short initially but eventually will catch up, however will be in lower half of target range

Small for gestational age (SGA)

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24
Q

Pathological causes of short stature (6)

A

Undernutrition

Chronic illness (juvenile idiopathic arthritis, IBD)

Iatrogenic (Steroids)

Psychosocial factors

Hormonal (growth hormone deficiency, hypothyroidism)

Genetic syndromes (turner, prader willi)

25
Q

Genetic syndromes that affect growth (4)

A

Turner syndrome (–> short stature in females)

Prader willi syndrome (–> short stature in males)

Noonan’s syndrome (–> short stature in both sexes)

Achondroplasia (–> short limbs –> disproportionate short stature)

26
Q

Clinical features of growth hormone deficiency (hypopituitarism) in newborns (3)

+ other clinical features in general (3)

A

hypoglycaemia,
prolonged jaundice,
micropenis

Excess subcutaneous tissue
Mid-face hypoplasia
Delayed skeletal maturation

27
Q

3 most common characteristics of Noonan syndrome

A

unusual facial features

short stature (restricted growth)

heart defects present at birth (congenital heart disease)

28
Q

What is achondroplasia + clinical features

A

Genetic bone growth disorder that causes disproportionate dwarfism

Normal sized trunk but short legs and arms
-mainly affects the upper arms and thighs

29
Q

What is turner syndrome + clinical features (5)

A

Chromosomal abnormality involving a complete/ partial absence of the second sex chromosome –> 45, X

Short stature
Underdeveloped ovaries (gonadal dysgenesis)
Webbed neck
Delayed puberty
Congenital heart defects
30
Q

What is prader willi syndrome + clinical features (4)

A

Chromosomal abnormality of chromosome 15

Excessive appetite –> overweight
Short stature
Intellectual impairment
Weak muscles (hypotonia)

31
Q

What is Noonan’s syndrome + clinical features (4)

A

Autosomal dominant inherited disorder

short stature,
facial dysmorphisms,
chest deformity,
congenital heart disease

32
Q

It’s common for males to have delayed puberty at what age and above + especially what group of boys does this occur in

A

> 14

Those with constitutional delay of growth and puberty (CDGP)

33
Q

Causes of delayed puberty (3)

A

Constitutional delay of growth and puberty (CDGP) - mainly boys

Gonadal dysgenesis (e.g. turner syndrome)

Chronic disease (e.g. crohn’s)

34
Q

What is thelarche

A

onset/appearance of breast development in girls - usually occurring at start of puberty

35
Q

What is infantile thelarche/ premature thelarche

A

Early sexual, specifically breast, development in females

Incomplete form of pubertal development without any other signs

Is a NORMAL VARIANT of pubertal development

36
Q

What is true/ central precocious puberty

+ what investigation needs to be done

A

Early puberty signs that’s thought to be linked with problems in the hypothalamus/pituitary gland (hence CENTRAL)

Hypothalamus starts releasing gonadotropin-releasing hormone at an earlier age than usual

  • -> early breast/testicular development
  • -> advanced bone age

MRI - TO EXLUDE PITUITARY TUMOUR

37
Q

What is premature pubarche

A

Normal variant of pubertal development in which pubic and/or axillary hair develops early

38
Q

What is adrenarche

A

early stage in sexual maturation where adrenal gland starts secreting increased levels of androgens which promote development of pubic hair, oily skin, oily hair, body odour

39
Q

Cause of central precocious puberty in girls v boys

A

Usually idiopathic in girls

Boys more likely to have a trigger like brain tumour

40
Q

What is precocious pseudopuberty

+ condition needs to be excluded

A

Partial pubertal development that results from gonadotropin-independent (i.e. independent of luteinizing hormone or follicle stimulating hormone) production of testosterone in a prepubertal boy

so testosterone secretion is abnormal

MUST EXCLUDE CAH

41
Q

What to assess in an obese child (4)

A

Weight
BMI
Height
Waist circumference

42
Q

If child is obese AND short, is this normal

A

No

Obese children are usually taller

43
Q

Pathological causes of obesity in children (4)

A

Genetic syndrome, e.g. prader willi

Hypothalamic-pituitary pathology

Endocrine disorders

Drugs, e.g. insulin, steroids

44
Q

Complications of obesity (6)

A 
Fatty liver disease
Gallstones
Reproductive dysfunction
Nutritional deficiencies
Sleep apnoea
Heart disease
45
Q

Drugs that can increase weight (4)

A

Inuslin
Steroids
Antithyroid drugs
Sodium valproate

46
Q

Genetic syndromes that cause obesity

A

Prader willi

Down’s syndrome

47
Q

Endocrine disorders that cause weight gain/obesity (5)

A 
Hypothyroidism
Growth hormone deficiency
Glucorticoid excess
Hypothalamic lesion, e.g. tumour, trauma (--> loss of appetite control)
Insulinoma
48
Q

Treatment of obesity (3)

A

diet change
Exercise
Psychological support

49
Q

Clinical features of hypopituitarism in adults (5) + children (4)

A

Children

  • dwarfism/short stature
  • slow growth
  • overweight
  • delayed puberty

Adults

  • premature ageing
  • fatigue
  • infertility
  • reduced sex drive
  • decreased body hair
50
Q

What is congenital adrenal hyperplasia

A

A group of autosomal recessive inherited enzyme deficiencies
- missing the enzyme that stimulates the adrenal glands to release corticosteroids, e.g. cortisol

51
Q

What condition is associated with females being born with virilised (male looking) genitalia

A

Congenital adrenal hyperplasia

52
Q

Clinical features of congenital adrenal hyperplasia (CAH) (5)

A

Dehydration –> hyponatraemia

hypoglycaemia

Weight loss

Vomiting

Ambiguous genitalia

53
Q

How to immediately test for diabetes in children

A

Finger prick capillary glucose test

If >11mmol/l then suspicious, phone specialist for same day review

54
Q

Typical 4 symptoms of type 1 diabetes

A

Thirsty
Fatigue
Weight loss
Peeing more

55
Q

Tools to assess growth in childhood

A 
Height/ length/ weight
Growth Charts and plotting
MPH and Target centiles
Growth velocity
Bone age
Pubertal assessment
56
Q

IGF-1 is a marker of what hormone

A

GH

57
Q

What simple medical instrument can be used to assess testicular volume

A

Orchidometer

58
Q

Puberty is considered early or delayed at what age

  • males
  • females
A

Males <9 (rare), >14

Females <8, >13 (rare)

59
Q

Commonest cause of acquired hypothyroidism in kids

+ symptoms/signs

A

Hashimoto’s thyroiditis

Symptoms/signs

  • lack of HEIGHT gain
  • pubertal delay

Year 2 - Endocrine (21 decks)

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