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Endocrine & Diabetes > Growth and puberty > Flashcards

Growth and puberty Flashcards

1
Q

What is growth?

A
  • Growth means an increase in some quantity over time.
  • The quantity can be physical (e.g., growth in height, growth in an amount of money) or abstract (e.g., a system becoming more complex, an organism becoming more mature).
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2
Q

How do we measure growth?

A

-Height
=Wall mounted stadiometer preferred
=Reproducible technique most important

-Length
=In those less than 2 years or cannot stand
=Requires an assistant

-Weight
=In underclothing or light clothing (from age 6 months)

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3
Q

When should a child be measured for growth?

A
  • All children should have their height and weight charted when they visit their doctor for any reason
  • Serial measurements are most valuable as they allow assessment of rate of growth ( = growth velocity)
  • Need to plot and interpret the data
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4
Q

What charts are recorded in measuring growth?

A 
-Growth charts
=Plot height and weight
-Height velocity charts
=Assess rate of growth – cm/year
-BMI charts
=Identify BMI out with normal range
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5
Q

What information is needed from both parents?

A

-Need height of each parent
-For a girl:
=plot mums height on chart
=plot dads height MINUS13 cm
-For a boy:
=plot Dads height on chart
=plot Mums height PLUS 13 cm
-Midpoint between the two = mid parental centile – plus or minus 6 cm

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6
Q

What are the 3 stages of growth?

A
  1. Infancy: 0 - ~2 years
  2. Childhood: 2 years – prepuberty
  3. Puberty: onset until reached final height and sexual maturation
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7
Q

What is faltering growth?

A
  • A baby or toddler is not growing at the rate that you would normally expect (not enough calories)
  • 5% of children under the age of two at some point.
  • It is not a condition in itself – there are lots of different possible explanations, with feeding problems being the most common
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8
Q

What are the causes for lack of weight gain in infancy?

A
  • Too little intake
  • Failure to absorb
  • Chronic disease
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9
Q

What are the key indicators of pathological growth in childhood?

A
  • Stature out with parental target height

- Slow growth or rapid growth (not being short or tall)

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10
Q

What needs to be asked in a history for growth disorders?

A
  • Duration
  • Severity
  • Emotional/ psychological
  • Developmental history
  • Social circumstances
  • Diet
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11
Q

What needs to be asked in a perinatal history?

A
  • Birth weight and length
  • Gestation
  • Drugs
  • Delivery
  • Infection
  • Jaundice
  • Oedema
  • Hypoglycaemia
  • Micropenis
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12
Q

What needs to be asked in a family history?

A
  • Short stature
  • Timing of puberty
  • Heritable disease
  • Endocrine disease
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13
Q

What systemic symptoms are noted in growth disorder history?

A
  • Chronic illness

- Neurological and nutritional review

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14
Q

Describe examination of growth disorders

A

-Measurement
=height, weight, head circumference, body proportions (arm span)
-Body habitus
=broad chest, truncal obesity, muscle bulk
-Dysmorphism
=facial, midline defects, ears, palate, others
-Hands and feet
=short metacarpals, clinodactyly, palmar creases, lymphoedema, clubbing
-Neurological
=Visual fields, acuity, fundi, nystagmus
-Puberty and genitalia
=Pubertal staging, penis size
-Signs of systemic illness

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15
Q

What is puberty?

A

-Period in the growth and
development of a child which encompasses the initiation and progression of sexual and physical maturation/ sexual maturation occurs resulting in the capacity for reproduction

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16
Q

What does puberty involve?

A

-Growth and maturation of primary sexual characteristics
(gonads and genitals)
-Appearance of secondary sexual characteristics
(sexual hair, female breast development, voice change etc)
-Stimulation of gonadal activity is by pulsatile
gonadotropin release from the pituitary gland

17
Q

Describe a history relating to puberty

A

-Family history of puberty
=Mother - menarche, growth spurt, cessation of growth
=Father - growth spurt, shaving cessation of growth

-History in the child
=Onset and progression of pubertal characteristics
=Pubic hair, axillary hair
=Breast development - usually recalled
=Onset of genital enlargement in boys - rarely recalled

18
Q

How is puberty examined?

A
  • Parent present, privacy, appropriate simple explanation

- Self staging using growth chart pictures if examination declined

19
Q

What is examined in girls for puberty?

A
  • Breast staging (buds)
  • Pubic hair
  • Axillary hair
  • Acne
  • Body habitus
20
Q

What is examined in boys for puberty?

A
  • Testicular volumes 4 ml (or length)- 10ml when growth spurt happening
  • Genital stage
  • Pubic hair
  • Axillary hair
  • Acne
  • Facial hair
  • Body habitus
21
Q

What are the normal ranges for boys?

A

-Testicular volumes = testosterone production
=Onset puberty = 4mls: age 11 yrs
=Onset growth spurt at 10 mls: age 13 yrs
=Adult male volumes of 25mls: age16 yrs

-Normal range start = 9-14 yrs
=Onset puberty pre 9yrs = precocious
=Onset puberty after 14 yrs = delayed
-Takes 5 yrs! Pubertal height gain 25 cm

22
Q

What are the normal ranges for girls?

A 
-Oestrogen production (ovaries enlarging)
=Onset puberty = breast bud and onset of growth spurt = 10.5 years
=End puberty = onset menses = 13 years
-Normal range to start  = 8 - 13 yrs
-Onset puberty before 8 yrs = precocious
-Onset puberty after 13 yrs = delayed
-Takes 2.5 yrs
=Growth after onset menses ~ 6 cm
23
Q

What is adrenarche?

A
  • Onset of production of adrenal androgens – 2 years or more – prior to onset of puberty.
  • Due to maturation of adrenal cortex – zona reticularis
  • Begins by 6-8 yrs in normal individuals
  • Presence or absence does not influence onset of true puberty
24
Q

What are the clinical features of adrenarche?

A
  • Axillary and/or pubic hair, greasy hair & skin, acne, body odour
  • > 95% variant of normal

-When should you worry?
=Sign of virilisation or rapid growth
-Pathological diagnoses:
=Androgen secreting tumour or late onset CAH
-Parents worry: onset of puberty – but ONLY if also signs of testicular enlargement or breast development

25
Q

Describe menstruation

A
  • Occurs at end of sexual maturation – B4-5
  • Mean age = 13 years
  • Range of normal: 11-15 yrs
  • Irregular cycles common
  • Depends on ethnicity (African American younger)
26
Q

What are pathological causes of growth disorders?

A

-Slow growth and thin?
=Chronic disease e.g. Coeliac disease, IBD
-Slow growth and fat?
=Endocrine problem e.g. hypothyroidism
-Rapid growth in childhood?
=Sex steroid exposure e.g. precocious puberty

27
Q

What is central precocious puberty?

A

-gonadotrophin dependent
=onset breast development before 8yrs
=Testicular volumes >3mls before 9yrs

=Central activation of pubertal axis
=Gonadal enlargement
=Normal sequence of events

28
Q

What is pseudopuberty?

A

-gonadotrophin independent
=disharmonious pubertal events
=Eg vaginal bleeding without breast development

=Peripheral activation of sex steroids
=Not centrally activated
=Incomplete pubertal sequence
=No gonadal enlargement
=eg. congenital adrenal hyperplasia
=ovarian tumour
29
Q

What concerns are raised by possible precocious sexual development?

A
  • Possible sinister underlying cause
  • Psychologically unacceptable – embarrassment of inappropriately early sexual changes, excessive tall stature, early onset menstruation.
  • Long term sequelae – short stature (but only if age at onset is < 7yrs in girls and < 8 yrs in boys
30
Q

What concerns are raised by delayed or incomplete sexual development?

A
  • Possibly a sinister underlying cause eg acquired hypothyroidism
  • Emotional and psychological upset of immaturity, esp when associated with short stature
  • Long term sequelae
31
Q

How does obesity affect puberty?

A
  • Increased linear growth rate

- Just get there sooner [earlier puberty] or at same time [blunted puberty growth spurt]

32
Q

How does McCune-Albright syndrome present?

A

-Large pigmented lesions

=Ovaries switch themselves on

33
Q

Describe hypopituitarism

A
  • Congenital – single or multiple pituitary deficiencies or SOD (septo-optic dysplasia)
  • Acquired - craniopharyngioma

-Presents as
=Height <1st centile
=Fat
=Prepubertal

34
Q

How does Turner’s syndrome present?

A

-Always short and growing more slowly
-No dysmorphic features
=Short, broad chest, webbed neck, increased carrying angle, hyperconvex nails, low posterior hair line, cardiac defects, renal anomalies

35
Q

Describe Acquired hypothyroidism

A
  • Often family history
  • May be overweight
  • Growth rate would be slow – unlike simple obesity where growth is faster.

Endocrine & Diabetes (45 decks)

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