Growth and Endocrine Flashcards by Lucy McLean

What is normal growth?

Wide range within healthy population
Different ethnic subgroups
Inequality in basic health and nutrition
Normality may relate to individuals or populations (genetic influence)

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How might you use parents to assess whether child’s growth normal?

Mid Parental Height (MPH) and Target Centile Range (TCR)

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What is a way of assessing bone age?

Tanner-Whitehouse TW 20

Uses hand bones

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What assessment tools can be used to assess growth?

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

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What might you look for in history and further examination?

Birth weight and gestation
PMH
Family history/social history/schooling

Systematic enquiry
Dysmorphic features
Systemic examination including pubertal assessment

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What are indications for referral for growth disorder?

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

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What are common causes of short stature?

Familial
Constitutional
SGA/IUGR
(small for gestational age and intrauterine growth restriction)

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When testing FBC and ferritin in growth disorder, what are you looking for?

General health
Coeliac
Chron’s
JCA

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When testing coeliac serology and IgA in growth disorder, what are you looking for?

Coeliac disease

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When testing U&E, LFT, Ca and CRP in growth disorder, what are you looking for?

General health
Renal and liver disease
Disorders of Ca metabolism

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When testing IGF-1, TFT, Prolactin and Cortisol (gonadotrophins and sex hormones) in growth disorder, what are you looking for?

Hormonal disorders

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When testing karyotype/microarray in growth disorder, what are you looking for?

Turner’s syndrome Chromosomal abnormalities

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If IGF1 id low, what might you do next?

Growth hormone stimulation test

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In isolated growth hormone deficiency, what might a pituitary MRI look like?

Ectopic posterior pituitary gland

Small anterior pituitary gland

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What is a method of staging puberty?

Tanner method

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Describe the Tanner method

B - 1 to 5 (breast development) 
G - 1 to 5 (genital development)
PH - 1 to 5 (pubic hair)
AH - 1 to 3 (axillary hair) 
T - 2ml to 20ml

SO eg statement as B3 PH3 or G2 PH2 6/6

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What defines early and delayed puberty in boys and girls?

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Boys

early <9years (rare)
delayed >14 (common, especially CDGP)

Girl

early <8 years
delayed >13 (rare)

What is CDGP?

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Constitutional Delay of Growth and Puberty (CDGP)
Boys mainly
Family history in dad or brothers (difficult to obtain!)
Bone age delay
Need to exclude organic disease

What are the essential in assessing puberty?

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Pubertal staging:

Breast budding (Tanner Stage B 2) in a girl
Testicular enlargement (Tanner Stage G2 -T 4 ml) in boy

Pubertal tempo

Normal pubertal age

What are some pathological causes of short stature?

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Undernutrition
Chronic illness (JCA, IBD, Coeliac)
Iatrogenic (steroids)
Psychological and social
Hormonal (GHD, hypothyroidism, glucocorticoid excess)
Syndromes (Turner, P-W, Noonan, PHPT)
Skeletal dysplasias

What are the features of Turner syndrome?

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45X
Short Stature
Ovarian dysgenesis

Associated disorders: cardiac, renal, thyroid, ENT problems
Psychosocial/educational difficulties
Physical stigmata

What are the features or Prader-Willi syndrome?

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Infantile hypotonia/feeding problems
Hyperphagia/obesity in childhood
Short stature 
Developmental delay
Hypogonadism 
Deletion of 15q11-q13 chromosomal region

What are the features of Noonan’s sydrome?

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Typical facial features
Short stature
Congenital heart disease
(pulmonary valve stenosis)

What is achondroplasia?

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Disorder of bone growth that prevents the changing of cartilage (particularly in the long bones of the arms and legs) to bone
It is characterised by dwarfism, limited range of motion at the elbows, large head size (macrocephaly), small fingers, and normal intelligence

What are the causes of delayed puberty?

Chronic disease (Crohn’s, asthma) and constitutional Primary gonadal disorders - Gonadal dysgenesis (Turner’s, Klinefelter’s, DSD) - Testicular irradiation Impaired HPG axis (septo-optic dysplasia, craniopharyngioma, Kallman’s syndrome)

breast

secondary

pv bleeding

What is central precocious puberty?

True pubertal development – Breast development in girls – Testicular enlargement in boys Growth spurt Advanced bone age Need to exclude pituitary lesion - MRI

What is precocious pseudopuberty?

Clinical picture: secondary sexual characteristics Gonadotrophin independent (low/prepubertal levels of LH and FSH) Most common Early Adrenarche Need to exclude Congenital Adrenal Hyperplasia!

How is obesity assessed?

``` Weight Body mass index (BMI) (kg/m2) • Height Waist circumference Skin folds History and examination Complications ```

Is it normal for a child to be obese and short?

What are causes of obesity?

* SIMPLE OBESITY (intake>output) * Drugs * Syndromes * Endocrine disorders * Hypothalamic damage

What are non-simple types of obesity and how do you recognise them?

Endocrine causes - growth failure Syndromes - learning difficulties Hypothalamic causes - loss of appetite control Genetic causes - starts before age 5

How might diabetes present? THINK

Sometimes referred to as the 4Ts Thirsty Tired Thinner Using the Toilet more

What is a red flag sign for diabetes?

A return to bedwetting or day-wetting in a previously dry child

How may diabetes present in children under 5?

``` Heavier than usual nappies Blurred vision Candidiasis (oral, vulval) Constipation Recurring skin infections Irritability Behaviour change ```

What are the signs of DKA?

``` Nausea & vomiting Abdominal pain Sweet smelling, "ketotic" breath Drowsiness Rapid, deep “sighing” respiration Coma ```

If you suspect DKA or type 1 diabetes, what must you do immediately? TEST

Finger prick capillary blood glucose test Result >11mmol/l - Diabetes Result <11mmol/l - Other cause DO NOT request a returned urine specimen. DO NOT arrange a fasting blood glucose test. DO NOT arrange an Oral Glucose Tolerance Test. DO NOT wait for lab results (urine or blood).

After testing blood glucose, what must you do? TELEPHONE

``` Call local specialist paediatric diabetes team for a same day review Diabetic Ketoacidosis (DKA) can occur very quickly in children If in any doubt about a diagnosis of Type 1 Diabetes call for advice Don’t delay the diagnosis ```

Summarise diagnosing diabetes

THINK – Symptoms - Thirsty - Thinner - Tired - Using the Toilet more TEST- Immediately - Finger prick capillary glucose test - If result >11mmol/l TELEPHONE – Urgently -Contact your local specialist team for a same day review

What is the blood glucose result that indicates diabetes?

>11mmol/l

Growth and Endocrine Flashcards

(42 cards)