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🍉paeds > growth and endocrine > Flashcards

growth and endocrine Flashcards

1
Q

Factors which affect growth:

A
  • Age
  • Sex
  • Race
  • Nutrition
  • Parental heights
  • Puberty
  • Skeletal maturity (bone age)
  • General health
  • Chronic disease
  • Specific growth disorders
  • Socio-economic status
  • Pyscho-social deprivation: Emotional well being
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2
Q

Key questions when assessing growth?

A

Is the kid too short or tall for their age

Has puberty started and is it progressing normally?

Is growth normal for stage of puberty?

Is child underweight, overweight or obese?

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3
Q

What is the most rapid phase if growth?

A

early in infantile phase (02)

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4
Q

What is involved in the assessment of puberty?

A

girls: pubic, axillary hair and breast development
boys: pubic, axillary hair and genital development in bonds

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5
Q

What is the onset of puberty in girls and boys?

A

girls: breast budding (tanner stage B2)
11years

Boys: testicular enlargement (tanner stage G2)
average age 11.5

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6
Q

difference in timeline in boy and girl puberty?

A

girls rapidly at start

boys start to accelerate until mid-puberty, 2 years later

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7
Q

why are boys taller?

A

more intense growth spurt

it starts 2 years laters

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8
Q

what is used to assess height?

A

stadiometer

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9
Q

when to measure an infant?

A

measure length without nappy or footwear before age of 2 years.

discrepancy when moving from supine to standing as it squares intervertebral disc

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10
Q

parent height comparator

A

the child’s most recent height centile up to age 8 gives a good idea of adult height for healthy children.

compare mid-parental gentile to the child’s current height gentile

9/10 children’s height gentile are with +/- within two gentile spaces of mid-parental centile

only 1 percent more than 3 gentile spaces below

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11
Q

what is just as important as measuring height?

A

Weight!

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12
Q

bmi equation?

A

weight (kg) / height m squared

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13
Q

what is an average weight of a child?

A

vmi between 25th and 75th percentile

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14
Q

what is ‘normal’ growth?

A

Precise definition difficult:
– 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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15
Q

Bone age

A

/

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16
Q

What assessment tools are used for growth?

A
  • Height/ length/ weight
  • Growth Charts and plotting
  • MPH and Target centiles
  • Growth velocity
  • Bone age
  • Pubertal assessment
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17
Q

What is specifically looked at during history and examination?

A
  • Birth weight
  • gestation
  • PMH
  • Family history/social history/schooling
  • Systematic enquiry- Dysmorphic features
  • Systemic examination including pubertal assessment
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18
Q

what are indication for referral if you suspect a growth disorder?

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
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19
Q

common causes of short stature?

A
  • Familial
  • Constitutional
  • SGA/IUGR
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20
Q

what tests should be done for short state?

A
  • FBC and ferritin: gen health, coeliac, Chrons, JCA
  • U&E, LFT, Ca, CRP: general disorders, renal and liver disease, disorders of Ca metabolism
  • Coeliac serology and IgA- coeliac
  • IGF-1, TFT, Prolactin, Cortisol, (gonadotrophins and sex hormones)- hormonal disorder
  • Karyotype/ Microarray - Turner’s syndrome, chromosomal abnormalities
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21
Q

How to stage puberty?

A

Tanner method?

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22
Q

tanner puberty- explained

A 
B: 1-5 (breast development)
• G 1-5  (gentital development)
• PH 1-5 (pubic hair)
• AH 1-5 (axillary hair)
•T  2ml to 20ml

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

23
Q

Hormons in puberty?

A

Hypothalmus - GnRH

Pituitary gland- LH, FSH

Boys: Testosterone

Girls: Estradiol

24
Q

when is it early and delayed puberty in boys?

A

early<9years (rare)

– delayed >14 (common, especially CDGP)

25
Q

when is it early and delayed puberty in girls?

A

early <8 years

– delayed >13 (rare)

26
Q

what is constitutional delay of Growth and Puberty? (CDGP)

A

Boys mainly
• Family history in dad or brothers (difficult to obtain!)
• Bone age delay
• Need to exclude organic disease

27
Q

when does puberty begin according to tanner?

A

Breast budding (Tanner Stage B 2) in a girl

– Testicular enlargement (Tanner Stage G2 -T 4 ml) in boy

28
Q

Pathological causes of short stature?

A

Undernutrition

  • Chronic illness (JCA, IBD, Coeliac)
  • Iatrogenic (steroids)
  • Psychological and social
  • Hormonal (GHD, hypothyroidism!!, glucocorticoid excess)
  • Syndromes (Turner!!, P-W, Noonan, PHPT)
  • Skeletal dysplasias
29
Q

what are features of thyroid deficiency?

A
  • Short Stature

- Ovarian dysgenesis

30
Q

what are the associated disorders of turners?

A

cardiac, renal, thyroid,ENT problems

Psychosocial/educational difficulties

• Physical stigmata

31
Q

Prader-Willi Syndrome features?

A
  • Infantile hypotonia/ feeding problems
  • Hyperphagia/ obesity in childhood
  • Short stature •Developmental delay/
  • Hypogonadism
  • Deletion of 15q11-q13 chromosomal region
32
Q

Noonan’s syndrome features?

A

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

33
Q

Achrondoplasia

A

.

34
Q

causes of delayed puberty?

A

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)

35
Q

what triggers breast development?

A

hypothalamic activation

36
Q

what triggers secondary sexual characteristics

A

ex steroid hormone secretion

37
Q

what is Central Precocious Puberty

A

early sexual development

True pubertal development
– Breast development in girls
– Testicular enlargement in boys
• Growth spurt
• Advanced bone age
38
Q

what should you exclude in Central Precocious Puberty

A

pituitary lesion—- MRI

39
Q

what is Precocious Pseudopuberty

A

partial pubertal development that results from autonomous (gonadotropin-independent) production of testosterone in a prepubertal boy.

40
Q

Precocious Pseudopuberty features?

A

Clinical picture: secondary sexual characteristics
• Gonadotrophin independent (low/prepubertal levels of LH and FSH)
• Most common Early Adrenarche

41
Q

what should you exclude in Precocious Pseudopuberty

A

Congenital Adrenal Hyperplasia!

42
Q

how many kids are obese?

A

Nearly a third (31%) of children aged 2–15 are overweight or obese1

43
Q

what to assess in an obese child?

A 
Weight
• Body mass index (BMI) (kg/m2) • Height
• Waist circumference
• Skin folds
• History and examination
• Complications
44
Q

obese and short:

A

abnormal

45
Q

what to look at in a history of an obese child?

A
  • Diet
  • Physical activity
  • Family history

Symptoms suggestive of
History

Syndrome Hypothalamic- pituitary pathology
Endocrinopathy Diabetes

46
Q

most common cause of obesity

A

simple obesity (high diet, low activity)

47
Q

4 symtoms of diabetes

A

Thirsty
Tired
Thinner
Toilet

48
Q

symptoms of diabetes common in under 5s?

A

heavier than usual nappies blurred vision
candidiasis (oral, vulval) constipation
recurring skin infections irritability, behaviour change

49
Q

red flag in a kid suggesting diabetes?

A

A return to bedwetting or day-wetting in a previously dry child is a “red flag” symptom for diabetes

50
Q

Diabetic Ketoacidosis DKA Symptoms

A

Nausea & vomiting

Abdo pain

sweet smelling “ketotic breath”

Drowsiness

Rapid, deep :sighing” respiration

Coma

51
Q

when to test for diabetes?

A

immediatly

52
Q

how to test for diabetes? what results suggest it?

A

Finger prick capillary blood glucose test

Result >11mmol/l - Diabetes Result <11mmol/l - Other cause

53
Q

what should u NOT do if suspect diabetes?

A

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).

54
Q

when should you get a local specialist to review child with diabetes?

A

Urgently!!
Same day!!

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

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