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Sarah Paeds > Growth & Puberty > Flashcards

Growth & Puberty Flashcards

1
Q

Four phases of growth

A

Fetal
Infant
Child
Pubertal

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2
Q

Factors affecting size of fetus

A 
Size of the mother 
Placentl nutrition (which modulates fetal growth factors)
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3
Q

Three examples of fetal growth factors

A

IGF2
Human placental lactogen
Insulin

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4
Q

What is the fastest period of growth?

A

Fetal

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5
Q

What is the effect of precocious puberty on stature?

A

Often shorter because earlier fusion of epiphyseal growth plates

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6
Q

Factors influencing infantile growth

A

Nutrition
Thyroid
Happiness

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7
Q

Factors influencing childhood growth

A

Thyroid
GH (IGF-1)
Happiness
Genes

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8
Q

Factors influencing pubertal growth

A

GH

Sex steroids

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9
Q

First sign of puberty in females. Age?

A 
Breast enlargement (8.5-12.5 years)
Growth spurt shortly after
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10
Q

First sign of puberty in males. Age?

A 
Testicular enlargement (>4ml vol). 9-13 years 
Growth spurt 18mos after
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11
Q

Commonest cause of cushing syndrome in children

A

Excess steroids

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12
Q

8 causes of short stature

A

Familial
Constitutional delay
Severe IUGR/preterm

Endocrine (thyroid, GH, IGF1)

Nutrition/chronic illness
Psychosocial

Syndromes
Skeletal abnormalities

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13
Q

Commonest cause of hypothyroid causing short stature

A

Autoimmune thyroiditis

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14
Q

Features of children with endocrine caused short stature

A

Often weight > height centile

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15
Q

Features of children with short stature caused by nutrition/chronic illness

A

Falling off centiles

Weight < height centile

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16
Q

Chronic illnesses commonly causing short stature

A

Coeliac
IBD (Crohn’s)
CKD

17
Q

Features of children with short stature due to constitutional delay

A

Leg growth is more mature than spine growth (pubertal growth is focused in the spine)

18
Q

Causes of constitutional delay

A

Familial

Diet/exercise

19
Q

Which syndromes can cause short stature

A

Turners
Noonan
Down
Russell-Silver

20
Q

Investigations for short stature

A

Growth charts
Clinical features
Bone age

FBC (Anaemia - coeliac/crohn’s)
Bone profile
TFTs
CRP/ESR (Crohn’s, chronic illness)

GH provocation tests
IGF-1

Karyotype

Abs (coeliac)

21
Q

How is bone age determined

A

X ray of hand and wrist

22
Q

Precocious puberty girls

A

8 years

23
Q

Precocious puberty boys

A

9 years

24
Q

Delayed puberty girls

A

13 years

25
Q

Delayed puberty boys

A

14 years

26
Q

Two types of precocious puberty

A

Gonadotrophin dependent (central)

Gonadotrophin independent

27
Q

Cause of precocious puberty in girls

A

Mostly familial/idiopathic

28
Q

Cause of precocious puberty in boys

A

More likely to have organic cause

  • Gonadal tumour (unilateral testis enlargement)
  • Adrenal issue (bilateral small testes)
  • Gonadotrophin release - from intracranial lesion (bilateral testes enlargement)
29
Q

Central precocious puberty management

A 
GnRH agonist 
GH therapy (GnRH agonists can stunt growth)
30
Q

What should be given with GnRH agonists to avoid growth stunting?

A

GH therapy

31
Q

Three types of delayed puberty

A

Constitutional
Hypogonadotrophic hypogonadism
Hypergonadotrophic hypogonadism

32
Q

Is delayed puberty more common in boys or girls?

A

Boys

33
Q

Examples of Hypogonadotrophic hypogonadism

A
  • Diet/exercise
  • Systemic disease, e.g. CF, Crohn’s, asthma
  • Acquired hypothyroidism
  • Hypothalamic-pituitary problems, e.g. tumours/Kallman’s
34
Q

Examples of Hypergonadotrophic hypogonadism

A
  • Turner’s
  • Klinefelter’s
  • Steroid hormone enzyme deficiencies
  • Acquired gonadal damage
35
Q

Mx delayed puberty in boys

A

OBSERVE

Oxandrolone - weak androgenic anabolic steroid induces catch up growth but not secondary sexual characteristics

36
Q

Mx delayed puberty in females

A

OBSERVE

Short course oestrogen

Sarah Paeds (20 decks)

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