Growth and Endocrine Flashcards
1
Q
Factors influencing height
A
Age Sex Race Nutrition Parental heights Puberty Skeletal maturity (bone age) General health chronic disease specific growth disorders socio-economic status emotional well being
2
Q
Measurement techniques
A
Sitting height
Head circumference
3
Q
Who Is head circumference routine in?
A
< 2 y /o
4
Q
Where do you put the tape in head circumference?
A
Tape around forehead and occipital prominence (maximal circumference)
5
Q
Assessment tools of growth
A
Height Length weight growth charts and plotting MPH and target centiles Growth velocity Bone age Pubertal assessment
6
Q
Indications for referral in growth disorders
A
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
7
Q
Common causes of short stature
A
Familial
Constitutional
SGA/IUGR
8
Q
Pathological causes of short stature
A
Undernutrition Chronic illness (JCA, IBD, coeliac) Iatrogenic (steroids) Psychological and social Hormonal (GHD, hypothyroidism) Syndromes (turner, P-W)
9
Q
What test would you do to look for turners syndrome?
A
Karyotype
10
Q
What tests would you do to look out for hormonal disorders?
A
IGF-1
TFT
prolactin
Cortisol (gonadotrophins and sex hormones)
11
Q
What tests do FBC and ferritin look at?
A
General health
coeliac disease
chrons
JCA
12
Q
Staging of puberty; the tanner method
A
B - 1-5 = breast development G - 1 - 5 = genital development PH - 1-5 pubic hair AH - 1-3 = axillary hair T - 2 ml to 20ml SO - e.g. statement as B3 PH3 or G2 PH2 6/6
13
Q
What is used to look at testicular maturation?
A
Prader orchidometer
14
Q
When is early development in boys and is it common or rare?
A
< 9 years
Rare
15
Q
When is delayed development in boys and is this common?
A
> 14 years
common, esp CDGP
16
Q
When is early development in girls?
A
< 8 years
17
Q
When is delayed development in girls and is this common?
A
> 13 y/o
rare
18
Q
What does CDGP stand for?
A
Constitutional delay of growth and puberty
19
Q
Who mainly gets CDGP?
A
Boys
20
Q
Features of CDGP
A
FH in brothers or dads (difficult to obtain)
Bone age delay
21
Q
What do you need to exclude in CDGP?
A
Organic disease
22
Q
Causes of delayed puberty
A
CDGP
Gonadal dysgenesis (turner 45X, Klinefelter 47 XXY)
Chronic disease (crohn’s, asthma)
Impaired HPG axis (septo-optic dysplasia, craniopharyngioma, kallmans syndrome)
Peripheral (cryptorchidism, testicular irridation)
23
Q
Presentation of early sexual development
A
Breast development Secondary sexual characteristics PV bleeding (early menarche)
24
Q
Causes of early sexual development
A
Hypothalamic activation
Sex steroid hormone secretion
25
Presentation of central precocious puberty
```
Pubertal development
- breast development in girls
- testicular enlargement in boys
Growth spurt
Advanced bone age
```
26
What do you need to exclude with central precocious puberty?
Pituitary lesion with an MRI
27
What is central precocious puberty?
Early sexual development
28
What is precocious pseudopuberty?
Abnormal sex steroid hormone secretion leading to partial pubertal development
29
Pathology of precocious pseudopuberty
Gonadotrophin independent
| Low/prepubertal levels of LH and FSH
30
What do you need to exclude in precocious pseudopuberty?
Congenital adrenal hyperplasia
31
Management of ambiguous genitalia
Do not guess
Exam of gonads and internal organs
Karyotype
32
In ambigious genitalia what do you have to exclude and why?
Congenital adrenal hyperplasia
| Risk of adrenal crisis in first 2 weeks of life
33
Causes of congenital hypothyroidism
Athyreosis / hypoplastic / ectopic
| Dyshormonogenic
34
When should treatment for congenital hypothyroidism be started?
Within first 2 weeks
35
Most common cause of acquired hypothyroidism
Autoimmune (hashimotos) thyroiditis
36
Childhood issues of hypothyroidism
lack of height gain
pubertal delay (or precocity)
poor school performance (but work steadily)
37
Assessment of obesity
```
weight
BMI
height
waist circumference
skin folds
history and exam
complications
```
38
Obese + what is abnormal?
Short
39
Some Complications of obesity
```
Fatty liver diseases
Repro dysfunction e.g. PCOS
Pancreatitis
injuries
Stress incontinence
LVH
atherosclerotic CV disease
Pancreatitis
nutritional deficiencies
```
40
Causes of obesity
```
Simple obesity
drugs
syndromes
endocrine disorders
hypothalamic damage
```
41
What is simple obesity?
Intake exceeds activity
42
Treatment of obesity
Diet
Exercise
Psychological input
43
What is the most common cause of obesity?
Simple obesity
44
Endocrine causes of obesity would also have signs of.....
Growth failure
45
Syndrome causes of obesity would also have signs of …...
LDs
46
Hypothalamic causes of obesity causes signs of.....
loss of appetite control
47
Symptoms of T1DM in children (the 4Ts)
thirsty
thinner
tired
using toilet more
48
What test to do and what result indicates T1DM in children?
Finger prick capillary glucose test
| result > 11 mol/l
49
What is a red flag symptom for diabetes?
A return to bedwetting or day wetting in a previously dry child
50
Indicators of DM in children < 5 y / o
```
Heavier than usual nappies
blurred vision
candidiasis (oral, vulval)
constipation
recurring skin infections
irritability, behaviour change
```
51
Symptoms of DKA
```
Nausea
Vomiting
Abdominal pain
Sweet smelling ketotic breath
drowsiness
Dehydration > 5%
rapid, deep "sighing" respiration - hyperventilation
coma
```
52
Test if suspect DKA
```
Serum blood ketones > 3
VBG
CBG
finger prick capillary blood glucose test
- > 11mol/l
```
53
Investigations if suspect DM
Finger prick blood glucose
| Same day review with paediatrician
54
What value of Finger prick blood glucose indicates DM?
> 11
55
What is another name for psychogenic polydipsia?
Habitual drinking
56
Features of habitual drinking vs DM symptoms
Habitual drinking - drink then pee
| DM - Pee then drink as compensating
57
Why in DKA do children have abdominal pain and vomiting?
GI upset
| Trying to get rid of the acid
58
What drives the acidosis in DKA?
Ketones
59
Biochemical features of DKA
```
Hyperglycaemia > 11
Ketosis (blood / urine)
Blood ketones > 3
Acidosis
- ph < 7.3
- HCO3 <15mmol/L
```
60
What type of blood gases aren't done in children?
Arterial (ABG)
61
Treatment of DKA
```
ABCDE
IV fluids by bolus (+sugar to the fluid)
- resus 10ml/kg 0.9% saline)
- maintenance + deficit 0.9% saline + dex + K+
IV insulin (1 hour after fluids)
- 0.1u/kg/h (no bolus)
- never stop infusion unless SC started
Prevent cerebral oedema
```
62
What must be avoided in the treatment of DKA?
BICARBONATE
63
Who has the highest risk of cerebral oedema in DKA?
Late teens - early 20s
64
Why do we check the electrolytes in DKA?
Vomiting
Giving fluids
Giving insulin brings down your K+
65
Monitoring in DKA
```
BG hourly
Ketones hourly
Electrolytes 4 hourly
Gases 4 hourly
Basic obs
Fluid input / output
Neuro obs
ECG
Weight
Behavioural change / headache
```
66
Presentation of cerebral oedema
Headache +/- vomiting
Irritability
Reduced consciousness level
Signs of increased ICP
67
What % of DKA episodes have cerebral oedema?
1%
68
Management of cerebral oedema
```
Exclude hypoglycaemia
Call for help
MANNITOL 1g/kg IMMEDIATELY
Fluid restriction
Elevate head end of bed
Consider ITU
CT scan
```
69
Examples of short acting insulins
Novorapid
Humalog
Actarapid
70
Examples of long acting insulins
Glargine / lantus
| Detemir / Levemir
71
Example of a intermediate acting insulin
Insulatard
72
Example of a mixed insulin
Novomix 30
73
When would your long acting insulins be given?
Same time every day as provide 24 hour cover
74
When are your short acting insulins given?
Before every meal
75
What does the dose of the short acting insulin depend on?
CHO load of meal
| BG
76
What does the continuous subcutaneous insulin infusion allow?
Very small amounts of insulin to be delivered
| Flexibility with activity and meals
77
Where are the normal injection sites in children?
Buttocks
Thighs
Abdomen
78
What is the commonest cause of polydipsia and polyuria in children?
Habitual drinking
79
What must be excluded before diagnosing habitual drinking?
UTI
| DM
80
Management of habitual drinking
```
Offer only water (especially at night)
Milk 500ml/day
Decrease amounts of flavoured/sweetened fluid
Re offer meals if not taken
Avoid sugar based foods
```
81
Presentation of central diabetes insipidus
```
Polyuria
Polydipsia - may include "odd fluids" if cannot access normal ones
May not have nocturnal eneuresis
Well otherwise
Glucose / urine normal (but dilute)
```
82
Pathology of central DI
Deficient secretion of ADH by pituitary gland
83
Causes of central DI
Brain abnormality in neonatal period
| Brain tumour or brain injury in older group
84
Investigations of central DI
MRI
85
Treatment of Central DI
ADH analogue - desmopressin (DDAVP)
86
Presentation of nephrogenic DI
Primary nocturnal eneuresis (never dry at night)
Polydipsia
- preferring water
- older child
May have tried desmopressin for NE but no effect
Mother may also drink 6 - 7L per day
87
Pathology of nephrogenic DI
Defective or absent ADH receptor sites
| Defective or absent aquaporin - trasports water at collecting duct
88
Treatment of nephrogenic DI
Indomethacin
Hydrocholorthiazide
Amiloride
89
Is diabetes insipidus common?
No
90
What karyotype is associated with kleinfelters?
47, XXY
91
Presentation of Kleinfelters syndrome
Taller than average
Lack of secondary sexual characteristics
Small, firm testes
Infertile
Gynaecomastia (increased incidence of breast ca)
ELEVATED gonadotrophins
92
Diagnosis of Kleinfelters is done by what?
Chromosomal analysis
93
What is Kallmans syndrome a recognised cause of?
Delayed puberty secondary to hypogonadotrophic hypogonadism
94
Inheritance of Kallmans syndrome
X linked recessive
95
Pathology of kallmans syndrome
Failure of GnRH secreting neurones to migrate to the hypothalamus
96
What would be the clues in many questions for kallmans syndrome?
Anosmia in a boy with lack of puberty
97
Presentation of kallmans syndrome
```
Delayed puberty
Hypogonadism
Cryptorchidism
Anosmia
Sex hormones LOW
LH and FSH levels are inappropriately LOW/NORMAL
Typical normal or above average height
Possibly
- cleft lip / palate
- visual / hearing deficits
```
98
Inheritance of androgen insensitivity syndrome
X linked recessive
99
Pathology of androgen insensitivity syndrome
End organ resistance to testosterone causing genotypically male children (46XY) to have the female phenotype.
100
Another name for complete androgren insensitivity syndrome
Testicular feminisation syndrome
101
Presentation of androgen insensitivity syndrome
Primary amenorrhea
Undescended testis causing groin swellings
Breast development may occur (due to conversion of testosterone to oestrogen)
102
Diagnosis of androgen insensitivity syndrome
Buccal smear or chromosomal analysis to reveal 46XY chromosome
103
Management of androgen insensitivity syndrome
Raise child as female
Bilateral orchidectomy
Oestrogen therapy
104
Why would you do a bilateral orchidectomy in androgen insensitivity syndrome?
Increased risk of testicular cancer due to undescended testis
