Growth and Puberty Flashcards
Give 5 determinants of growth.
- Parental phenotype and genotype.
- Quality of pregnancy.
- Nutrition.
- Psychosocial deprivation.
- Hormones.
When is growth velocity fastest?
In utero and in infancy.
What is hypochondroplasia?
A developmental disorder resulting in short limbs.
Give 3 causes of inaccurate height/length measurements.
- Inaccuracy due to faulty technique/equipment.
- Uncooperative patient.
- Different observers.
- Different times of day.
Give 10 differentials for short stature.
- Constitutional delay.
- Slow maturation.
- Delayed puberty.
- Idiopathic.
- Environmental.
- Nutrition.
- Skeletal disease.
- Physical disease e.g. coeliac, IBD, CHD.
- Turner’s syndrome.
- Endocrine pathology.
What can cause an increased final height?
- Androgen/oestrogen deficiency.
- GH excess.
- Marfan’s.
- Klinefelter’s.
What are the 4 steps used in the assessment of growth?
- Initial measurement.
- Recording - ensure correct documentation.
- Interpretation.
- Action.
Name the scale that is used to describe physical development based on external sex characteristics.
Tanner scale.
Define thelarche.
Breast development.
Define adrenarche.
Maturation of the adrenal gland -> androgen production -> body odour and mild acne.
Define pubarche.
Growth of pubic hair.
What is the first sign of puberty in boys?
First ejaculation and testicular size >4ml.
Define delayed puberty.
In boys: the absence of testicular development (or a testicular volume lower than 4 ml) by age 14 years.
In girls: the absence of breast development by the age of 13 years, or primary amenorrhoea with normal breast development by the age of 15
What is the likely cause of delayed puberty in boys?
Constitutional delay - runs in the family.
What must you rule out as a cause of delayed puberty in girls?
Turner syndrome (45X0).
Give 3 potential consequences of delayed puberty.
- Psychological problems.
- Reproduction defects.
- Reduced bone mass.
How might you investigate delayed puberty?
FBC, U+E, TFT’s, LH/FSH, karyotyping.
Define precocious puberty.
development of secondary sexual characteristics before 8 years in females and 9 years in males
What must you rule out as a cause of precocious puberty in boys?
Brain tumour.
How would you treat precocious puberty?
GnRH super-agonists can be given to suppress pulsatility of GnRH secretion.
What is hypergonadotropic hypogonadism?
Primary gonadal failure e.g. testes/ovarian failure.
What is the affect of hypergonadotropic hypogonadism on the following:
a) FSH/LH.
b) Oestrogen/testosterone.
a) High FSH/LH.
b) Low oestrogen/testosterone.
Name 2 diseases that are examples of hypergonadotropic hypogonadism.
- Turner syndrome (45X0).
2. Klinefelter syndrome (47XXY).
What is hypogonadotropic hypogonadism?
Secondary gonadal failure e.g. hypopituitary or hypothalamic problem.
What is the affect of hypogonadotropic hypogonadism on the following:
a) FSH/LH.
b) Oestrogen/testosterone.
a) Low FSH/LH.
b) High oestrogen/testosterone.
Name a disease that is an example of hypogonadotropic hypogonadism.
Kallman syndrome.
Give 3 signs of Klinefelter syndrome.
- often taller than average
- lack of secondary sexual characteristics
- small, firm testes
- infertile
- gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels but low testosterone
Briefly describe the pathophysiology behind Kallman syndrome.
There is a congenital deficiency of GnRH meaning the pituitary isn’t stimulated to release FSH and LH this leads to secondary gonadal failure.
What inheritance pattern is seen in Kallman syndrome?
X linked recessive or dominant.
75% of people with which syndrome may have anosmia?
Kallman syndrome.
Define faltering growth.
The failure to gain adequate weight or achieve adequate growth during infancy and childhood. NICE defines faltering growth as weight that has fallen down 2 centile lines.
Give 5 broad causes of poor growth.
- Inadequate calorie intake.
- Malabsorption.
- Inadequate retention.
- Increased calorie requirements.
- Inflammatory disease.
Causes of faltering growth: give examples of inadequate calorie intake.
- Impaired suck/swallow.
- Inadequate availability of food.
- Psychosocial deprivation.
- Exclusion diets e.g. veganism
- Cleft palate.
Causes of faltering growth: give examples of malabsorption.
- Coeliac disease.
- Pancreatic disease e.g. CF.
- Liver disease.
- Enteropathy e.g. infective causes - giardia.
- Cows milk protein intolerance.
Causes of faltering growth: give an example of inadequate retention.
Vomiting e.g. severe GORD, pyloric stenosis.
Causes of faltering growth: give example increased calorie requirements.
- Chronic illness e.g. CHD, CKD, CF.
- Thyrotoxicosis.
- Malignancy.
Name 3 members of the MDT who would be involved in the management of a child with faltering growth.
- Health visitor.
- Dietitian.
- Community paediatrician.
Why is prompt intervention important when managing a child with faltering growth?
Prompt intervention can avoid problems such as cognitive delay, feeding and behavioural problems and low maternal self-esteem.
