Growth and Endocrine Flashcards
1
Q
How should growth be measured and plotted?
A
- Accuracy is important
- Value of serial measurements: make every contact count
- Different types of centile charts (UK, Boy/girl, condition specific)
- Identify target height and mid parental height (MPH)
- BMI
2
Q
Growth measurement techniques
A
- Length
- Height
- Sitting height
- Head circumference (routine in <2)
3
Q
What is important when establishing bone age?
A
- Radiographs must be of high quality
- Evaluation by skilled practitioner
- Pathological conditions can distort bones
- Severe osteopenia confuses interpretations
4
Q
What is the Tanner method of pubertal staging?
A
- Breast development (B) 1 to 5
- Genital development (G) 1 to 5
- Pubic hair (PH) 1 to 5
- Axillary hair (AH) to 3
- Testicular volume (T) 2ml to 20ml
5
Q
How is testicular maturation assessed?
A
Prader orchidometer
6
Q
Why is a precise definition of normal growth difficult to establish?
A
- Wide range within healthy population
- Different ethnic subgroups
- Inequality in basic health and nutrition
- Normality may relate to individuals or populations (genetic influence)
7
Q
What factors influence height?
A
- Age
- Sex
- Ethnicity
- Nutrition
- Parental heights
- Puberty
- Skeletal maturity (bone age)
- General health
- Socio-economic status
8
Q
What hormones are involved in puberty?
A
- Growth hormones
- Sex hormones
9
Q
What are the clinically most important stages in puberty?
A
- Breast budding (Tanner stage B2) in a girl
- Testicular enlargement (Tanner stage G2/T3-4ml)
- These are the earliest objective signs of puberty and when present puberty will usually progress onwards
10
Q
Growth disorders: Give examples of indications for referral
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
11
Q
What are common causes of short stature
A
- Familial
- Constitutional
- SGA/IUGR (Small for gestational age)
12
Q
What are the pathological causes of short stature?
A
- Undernutrition
- Chronic illness (JCA, IBD, Coeliac)
- Iatrogenic (steroids)
- Psychological and social
- Hormonal (GHD, hypothyroidism)
- Syndromes (Turner, Prader Willi)
13
Q
Precocious puberty
A
Precocious puberty is defined as the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys.
14
Q
Delayed puberty
A
- Boys have no signs of testicular development by 14 years of age
- Girls have not started to develop breasts by 13 years of age, or have developed breats but their periods have not started by 15
15
Q
Who does constitutional delay of growth usually affect?
A
- Boys
- particularly those with a family history (dad and brothers, though may difficult to obtain)
16
Q
Why does constitutional delay of growth occur?
A
There is bone age delay
17
Q
Give examples of causes of delated puberty
A
- Gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
- Chronic disease (Crohn’s, asthma)
- Impaired HPG (hypothalamic pituitary gonadal) axis (septo-optic dysplasia, craniopharyngioma, Kallman’s syndrome)
- Peripheral (cryptorchidism, testicular irradiation)
18
Q
What does central precocious puberty present with?
A
- Breast development in girls
- Testicular enlargement in boys
- Growth spurt
- Advanced bone age
19
Q
What causes central precocious puberty?
A
- Usually idiopathic in girls but pituitary imaging (MRI) should be done
- Underlying cause i.e. pituitary lesion
20
Q
How is central precocious puberty treated?
A
GnRH analogue therapy
21
Q
How should you manage the new-born with ambiguous genitalia?
A
- Do not guess the sex of the baby
- Multidisciplinary approach (paediatrics, endocrine, surgery, neonatologist, geneticist, psychologist)
- Exam: gonads?/internal organs
- Karyotype
- Exclude congenital adrenal hyperplasia (Risk of adrenal crisis in first 2 weeks of life)
22
Q
How many births are affected by congenital hypothyroidism?
A
1 in 4000
23
Q
What causes congenital hypothyroidism?
A
- Athyreosis/hypoplastic/ectopic
- Dyshormonogenic
24
Q
When should treatment for congenital hypothyroidism be started?
A
New born screening followed by commencement of treatment within the first 2 weeks
25
What is the most common cause of acquired hypothyroidism?
Autoimmune (Hashimoto's) thyroiditis
26
What issues does acquired hypothyroidism present with in childhood?
* Lack of height gain
* Pubertal delay (or precocity)
* Poor school performance (but work steadily)
27
How many children are overweight or obese?
Nearly a third (31%) of children aged 2-15 are overweight or obese
28
Define overweight
* BMI 25-30
* BMI\>85th centile or SD \>1.04
29
Define obese
* BMI \>30
* BMI\>97.5th centile or SD \>2
30
How should an individual be assessed for obesity?
* Weight
* Height
* Body mass index (BMI) (kg/m2)
* Waist circumference
* Skin folds
* History and examination
31
What is important when examining someone when assessing their obesity?
* Dark velvet rash indicative of diabetes
* Goitre
* BP
* Imaging of pituitary
32
Give examples of obesity complications.
* Fatty liver disease (non-alcoholic steatohepatitis) -Gallstones -Reproductive dysfunction (e.g. PCOS) Pancreatitis -Central hypoventilation -Obstructive sleep apnoea -Gastroesophageal reflux disease -Orthopaedic problems (slipped capital femoral epiphysis, tibia vara)
33
What can obesity be caused by?
* Simple obesity
* Drugs
* Syndromes
* Endocrine disorders
* Hypothalamic damage
34
What drugs can cause obesity?
* Insulin
* Steroids
* Antithyroid drugs
* Sodium valproate
35
What syndromes can cause obesity?
* Prader Willi syndrome
* Laurence-Moon Biedl syndrome
* Pseudohypoparathyroidism type I
* Down's syndrome
36
What endocrine disorders can cause obesity?
* Hypothyroidism
* Growth hormone deficiency
* Glucocorticoid excess
* Hypothalamic lesion (tumour/trauma/infection)
* Androgen excess
* Insulinoma
* Insulin resistance syndromes
* Leptin deficiency
37
What is the treatment for obesity?
* Diet
* Exercise
* Psychological input
* Rarely drugs
* Surgery
38
What is the most common cause of obesity?
* Simple obesity
* Increased intake
* Decreased activity
39
How is an early diagnosis of T1DM made in children?
THINK symptoms
* Thirsty
* Thinner
* Tired
* Toilet more often
40
What additional symptoms are there in children under 5 with T1DM?
* Heavier than usual nappies
* Blurred vision
* Candidiasis (oral, vulval)
* Constipation
* Recurring skin infections
* Irritability, behaviour change
41
What is a red flag symptom for T1DM in a child who is toilet trained?
A return to bedwetting or day wetting in a previously dry child is a red flag symptom for diabetes
42
What should you do if a child presents with suspected T1DM?
* Test immediately
* Finger prick capillary glucose test. If result \>11mmol/l then diabetes, if \<11mmol/l other cause
43
What should you if a child with suspected T1DM finger prick test is over 11mmol/l?
* Telephone urgently
* Contact your local specialist team for a same day review
* DKA can occur very quickly in children
* If in any doubt about a diagnosis of type I diabetes call for advice
* Don't delay the diagnosis
44
What are the symptoms of DKA?
* Nausea and vomiting
* Abdominal pain
* Sweet smelling 'ketotic' breath
* Drowsiness
* Kussmaul breathing
* Coma
