Growth and Endocrine Flashcards
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)
How might you use parents to assess whether child’s growth normal?
Mid Parental Height (MPH) and Target Centile Range (TCR)
What is a way of assessing bone age?
Tanner-Whitehouse TW 20
Uses hand bones
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
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
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
What are common causes of short stature?
Familial
Constitutional
SGA/IUGR
(small for gestational age and intrauterine growth restriction)
When testing FBC and ferritin in growth disorder, what are you looking for?
General health
Coeliac
Chron’s
JCA
When testing coeliac serology and IgA in growth disorder, what are you looking for?
Coeliac disease
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
When testing IGF-1, TFT, Prolactin and Cortisol (gonadotrophins and sex hormones) in growth disorder, what are you looking for?
Hormonal disorders
When testing karyotype/microarray in growth disorder, what are you looking for?
Turner’s syndrome Chromosomal abnormalities
If IGF1 id low, what might you do next?
Growth hormone stimulation test
-
In isolated growth hormone deficiency, what might a pituitary MRI look like?
Ectopic posterior pituitary gland
Small anterior pituitary gland
What is a method of staging puberty?
Tanner method
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
What defines early and delayed puberty in boys and girls?
Boys
- early <9years (rare)
- delayed >14 (common, especially CDGP)
Girl
- early <8 years
- delayed >13 (rare)
What is CDGP?
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?
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?
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?
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?
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?
Typical facial features
Short stature
Congenital heart disease
(pulmonary valve stenosis)
What is achondroplasia?
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
z
secondary
z
pv bleeding
z
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?
No
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
