Growth Disorders Flashcards

1
Q

Includes

A

.Acromegaly & Gigantism
Growth Charting
Pubertal Assessment
Childhood obesity & growth

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2
Q

What two conditions arise from hypersecretion of GH?

A

Gigantism - Pituitary tumour occuring before closure of epiphyseal plates leading to excess long bone growth

Acromegaly - Pituitary tumour occuring after epiphyseal plate closure leading to enlarged hands/feer, acromegalic facies and other symptoms

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3
Q

How would we treat conditions arising from excess GH?

A

Normally due to a pituitary tumour so:

  • Surgical removal
  • Somatostatin Analogues
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4
Q

What methods do we use to assess growth?

A
  • Height/length and weight
  • Growth charting
  • Midparental height & target centiles
  • Growth velocity
  • Bone age
  • Pubertal Assessment i.e. Tanner’s Stages
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5
Q

How is growth charted?

A

Age vs height graphs with pre-drawn centiles.
You want to see a child is growing within the centiles and at a normal velocity (i.e. not crossing centiles)

There are also condition-specific charts for illnesses that affect growth such as Turner’s syndrome of Down’s Syndrome

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6
Q

What are the parts of Tanner’s pubertal assessment?

A
Breast size 1-5
Genital Development 1-5
Pubic Hair 1-5
Axillary Hair 1-3
Testicular volume 2-20ml

The hairs are examples of secondary sexual characteristics (i.e. brought on by androgens not sex steroids)

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7
Q

Describe a pattern of normal growth from birth to 20?

A
  • High height gain at birth decreasing through infancy
  • Plateu/steadily decreasing height gain during childhood
  • Huge growth spurt during puberty (girls before boys)
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8
Q

What non-pathological factors are important when considering abnormal growth?

A
  • Race
  • Gender
  • Parental Heights
  • early/late onset puberty
  • Poor health
  • Socio-economic factors (e.g. poor nutrition)
  • Psycho-social deprivation (Can profoundly stunt growth)
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9
Q

What are the earliest signs of puberty & when does it start?

A

Breast budding in girls and testicular enlargement in boys.

Normal puberty occurs at 8-13 in girls and 9-14 in boys

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10
Q

How does obesity affect growth and puberty?

A

Obese children tend to hit puberty earlier, so growing taller earlier.
But will stop growing earlier and so end up the same height as non-obese children

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11
Q

What are the indications for referal (in reference to growth)?

A
  • Off centiles in height
  • Crossing centiles (abnormal velocity)
  • Chronic disease stunting growth
  • Obvious dysmorphic features
  • Early/late puberty
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12
Q

What can cause childhood obesity?

A
  • Simple obesity
  • Drugs e.g. insulin or steroids
  • Syndromes e.g. Downs
  • Endocrine disorders e.g. hypothyroidism
  • Hypothalamic damage (loss of appetite control)
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13
Q

How do you treat childhood obesity?

A

Diet
Exercise
Psychological Input

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14
Q

What are the normal non-pathological causes for a short stature?

A
  • Familial (your families just short)
  • SGA (small for gestational age)
  • Constitutional delay in growth and puberty (CDGP)
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15
Q

What is CDGP?

A

Mainly occurs in boys so look for a family history from brothers/dad

Its where you go through puberty a year or two late and have a bone-age delay. Perfectly normal and not worrying.

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16
Q

What are the non-normal causes of a short stature?

A
  • Undernutrition
  • Chronic illness
  • psychosocial
  • Hormonal (hypothyroidism or GH deficiency)
  • Syndromes (turner or Prader-Willi)
17
Q

What could cause delayed puberty? (mainly in boys)

A
  • CDGP
  • Gonadal Dysgenesis (e.g. Turner 45X or Klinefelter 47XXY
  • Chronic disease
  • Impaired HPG axis
  • Cryptorchidism (no testes) or Testicular irradiation (cancer patient)
18
Q

What are the types of early puberty? (mainly girls)

A
  • Infantile or premature thelarche (breast buds), the rest of puberty occurs at the normal age
  • Exaggerated adrenarche
  • Precocious pseudopuberty (Early adrenarche)
  • Premature Menarche
  • True Central Prococious Puberty
19
Q

What is true central precocious puberty?

A

Early sex hormone production

It may be idiopathic or possibly a brain tumour

20
Q

How do you treat true central precocious puberty?

A

GnRH analogue

21
Q

How would we approach a child born with ambiguous genitalia?

A

Firstly dont guess the gender

  • Examine for gonads
  • US for internal sexual organs
  • Karyotyping

Important to exclude congenital adrenal hyperplasia as it can cause adrenal crisis

22
Q

What are the types of hypothyroisism in kids?

A

Congenital - screen new borns and treat within 2 weeks

Acquired - Commonly Autoimmune Thyroiditis. Look for a FH of thyroid or autoimmune disorders