growth and endocrine Flashcards
Factors which affect growth:
- 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
Key questions when assessing growth?
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?
What is the most rapid phase if growth?
early in infantile phase (02)
What is involved in the assessment of puberty?
girls: pubic, axillary hair and breast development
boys: pubic, axillary hair and genital development in bonds
What is the onset of puberty in girls and boys?
girls: breast budding (tanner stage B2)
11years
Boys: testicular enlargement (tanner stage G2)
average age 11.5
difference in timeline in boy and girl puberty?
girls rapidly at start
boys start to accelerate until mid-puberty, 2 years later
why are boys taller?
more intense growth spurt
it starts 2 years laters
what is used to assess height?
stadiometer
when to measure an infant?
measure length without nappy or footwear before age of 2 years.
discrepancy when moving from supine to standing as it squares intervertebral disc
parent height comparator
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
what is just as important as measuring height?
Weight!
bmi equation?
weight (kg) / height m squared
what is an average weight of a child?
vmi between 25th and 75th percentile
what is ‘normal’ growth?
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)
Bone age
/
What assessment tools are used for growth?
- Height/ length/ weight
- Growth Charts and plotting
- MPH and Target centiles
- Growth velocity
- Bone age
- Pubertal assessment
What is specifically looked at during history and examination?
- Birth weight
- gestation
- PMH
- Family history/social history/schooling
- Systematic enquiry- Dysmorphic features
- Systemic examination including pubertal assessment
what are indication for referral if you suspect a 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
common causes of short stature?
- Familial
- Constitutional
- SGA/IUGR
what tests should be done for short state?
- 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
How to stage puberty?
Tanner method?
tanner puberty- explained
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
Hormons in puberty?
Hypothalmus - GnRH
Pituitary gland- LH, FSH
Boys: Testosterone
Girls: Estradiol
when is it early and delayed puberty in boys?
early<9years (rare)
– delayed >14 (common, especially CDGP)
when is it early and delayed puberty in girls?
early <8 years
– delayed >13 (rare)
what is 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
when does puberty begin according to tanner?
Breast budding (Tanner Stage B 2) in a girl
– Testicular enlargement (Tanner Stage G2 -T 4 ml) in boy
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 features of thyroid deficiency?
- Short Stature
- Ovarian dysgenesis
what are the associated disorders of turners?
cardiac, renal, thyroid,ENT problems
Psychosocial/educational difficulties
• Physical stigmata
Prader-Willi Syndrome features?
- Infantile hypotonia/ feeding problems
- Hyperphagia/ obesity in childhood
- Short stature •Developmental delay/
- Hypogonadism
- Deletion of 15q11-q13 chromosomal region
Noonan’s syndrome features?
Typical facial features
• Short stature
• Congenital heart disease
(pulmonary valve stenosis)
Achrondoplasia
.
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)
what triggers breast development?
hypothalamic activation
what triggers secondary sexual characteristics
ex steroid hormone secretion
what is Central Precocious Puberty
early sexual development
True pubertal development – Breast development in girls – Testicular enlargement in boys • Growth spurt • Advanced bone age
what should you exclude in Central Precocious Puberty
pituitary lesion—- MRI
what is Precocious Pseudopuberty
partial pubertal development that results from autonomous (gonadotropin-independent) production of testosterone in a prepubertal boy.
Precocious Pseudopuberty features?
Clinical picture: secondary sexual characteristics
• Gonadotrophin independent (low/prepubertal levels of LH and FSH)
• Most common Early Adrenarche
what should you exclude in Precocious Pseudopuberty
Congenital Adrenal Hyperplasia!
how many kids are obese?
Nearly a third (31%) of children aged 2–15 are overweight or obese1
what to assess in an obese child?
Weight • Body mass index (BMI) (kg/m2) • Height • Waist circumference • Skin folds • History and examination • Complications
obese and short:
abnormal
what to look at in a history of an obese child?
- Diet
- Physical activity
- Family history
Symptoms suggestive of
History
Syndrome Hypothalamic- pituitary pathology
Endocrinopathy Diabetes
most common cause of obesity
simple obesity (high diet, low activity)
4 symtoms of diabetes
Thirsty
Tired
Thinner
Toilet
symptoms of diabetes common in under 5s?
heavier than usual nappies blurred vision
candidiasis (oral, vulval) constipation
recurring skin infections irritability, behaviour change
red flag in a kid suggesting diabetes?
A return to bedwetting or day-wetting in a previously dry child is a “red flag” symptom for diabetes
Diabetic Ketoacidosis DKA Symptoms
Nausea & vomiting
Abdo pain
sweet smelling “ketotic breath”
Drowsiness
Rapid, deep :sighing” respiration
Coma
when to test for diabetes?
immediatly
how to test for diabetes? what results suggest it?
Finger prick capillary blood glucose test
Result >11mmol/l - Diabetes Result <11mmol/l - Other cause
what should u NOT do if suspect diabetes?
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).
when should you get a local specialist to review child with diabetes?
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
