Growth + Endocrine

Question 1

outline 5 ways that you could measure growth in a child?

Answer 1

• weight
• height
• head circumference
• growth velocity
• bone age

Question 2

outline the main responsible factors for growth between:

0-18months

1-12years

puberty

Answer 2

• 0-18months
  
  • nutritional
• 1-12 years
  
  • GH, Thyroid hormone
• Puberty
  
  • GH, oestrogen/testosterone

Question 3

what is FTT and outline most common causes of it

Answer 3

fall across growth deciles

• coeliac
• crohn’s
• GORD
• CF
• hypothyroidism
• inborn errors of metabolism

Question 4

what are some common causes of short stature?

Answer 4

• common
  
  • ​familial
  • SGA
  • IUGR
• pathological
  
  • ​undernutrition
  • iatrogenic - steroids
  • endocrine - GHD, hypothyroidism
  • chronic illness
  • syndromes - Turner/ Prader-Willis

Question 5

investigations for short stature?

Answer 5

• FBC, Ferritin
• U&E, LFT, Calcium, ESR, CRP
• TFT, ILGF1, Cortisol
• karytotype - Turner’s
• coeliac serology+ IgA

Question 6

what is a method used for puberty staging?

Answer 6

Tanner method

Question 7

outline when early + delayed puberty occurs for boys and girls

Answer 7

boys

• early - <9 years
• late >16 years

girls

• early <8 years
• late >14 years

Question 8

what is constitutional delay of growth and puberty (CDGP)?

Answer 8

delay in growth and puberty not due to any underlying abnormality. Cause is bone age delay

Question 9

aetiology of delayed puberty (5)

Answer 9

• CONSTITUTIONAL
  
  • more common in boys, FH +ve
• MALNUTRITION/CHRONIC ILLNESS
• ENDOCRINE
  
  • hypothalamic /pituitary disorder
  • hypothyroidism
• CHROMOSOMAL
  
  • turner’s
  • klinefelter’s
• GONADAL DYSGENESIS

Question 10

Ix and Mx of delayed puberty?

Answer 10

Ix- wrist x ray for bone age

Mx- treat underlying cause

Question 11

what is early sexual development characterised by in girls

Answer 11

• thelarche
  
  • breast development
• adrenarche
  
  • pubic hair development

Question 12

aetiology of precocious puberty

Answer 12

• CONSTITUTIONAL
  
  • isolated thelarche & adrenarche
• CENTRAL
  
  • intracranial tumour
• PERIPHERAL
  
  • CAH

Question 13

outline the features of precocious pseudopuberty

Answer 13

• abnormal secretion of sex steroid hormones
• clinically –> secondary sexual characteristics
• absence of gonadotrophins (LH and FSH)

Question 14

what do you need to exclude in precocious pseudopuberty?

Answer 14

congenital adrenal hyperplasia

Question 15

causes of congenital hypothyroidism?

Answer 15

• ATHYREOSIS- absence of it
• hypoplastic
• ectopic
• dyshormonogenic

Question 16

most common cause of aquired hypothyroidism?

Answer 16

• autoimmune thyroiditis (Hashimoto’s)
• often will have a FH of autoimmune / thyroid disorder

Question 17

childhood issues related to having aquired hypothyroidism?

Answer 17

• poor height growth
• delayed puberty
• reduced performance in school

Question 18

causes of obesity in children?

Answer 18

• simple obesity ie underactivity
• endocrine
• hypothlamic
• iatrogenic - drugs
• syndromes - learning difficulties

Question 19

symptoms of DM Type 1 in children and investigations

Answer 19

4T’S:

• thinner
• thirsty
• tired
• going to Toilet more

Investigations:

• finger prick blood glucose test
• if > 11mmol/l –> DM
• phone for same day review

Question 20

symptoms of DKA

Answer 20

• nausea / vomiting
• abdominal pain
• drowsiness
• sweet smelling breath
• rapid + deep sighing respiration (kussmaul breathing)