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Endocrine > Growth, puberty and Paediatric Problems > Flashcards

Growth, puberty and Paediatric Problems Flashcards

1
Q

what measurement techniques are available for height?

A

stadometre

lestre metre

avoid measuring tapes

ask to take deep breath - adds a few mm to height

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2
Q

how are children under two measured?

A

by legnth

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3
Q

when is sitting height useful?

A

short spine

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4
Q

when is head circumference measured in children?

A

Routine in children <2
years

Tape round forehead and
occipital prominence
(maximal circumference)

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5
Q

how important is it to be accurate in measuring and plotting on a graph?

A

make every dot and contact count

very important

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6
Q

what does a girls versus a boys centile chart look like?

A
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7
Q

can you get condition specific growth charts?

A

yes

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8
Q

how do you calculate Target Height and Mid Parental
Height (MPH)?

A

The mid parental height is calculated in males, by adding 7cm to the mean of parental heights; in females by subtracting 7cm.

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9
Q

how is BMI calculated?

A

Body Mass Index (BMI) is a person’s weight in kilograms (or pounds) divided by the square of height in meters (or feet)

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10
Q

what is bone age?

A

Bone xray of left wrist
Tana white house - 20 bones long and round - compare bone maturation to different stages of maturation in the atlas give a score to each bone and that gives you bone age

Bone age very close to pubertal timing

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11
Q

how is puberty staged using the tanner method?

A
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12
Q

describe the tanner stages?

A
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13
Q

how is testicular maturation measured?

A

Prader Orchidometer

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14
Q

what should be covered in history and examination in relation to a childs height?

A

Birth weight and gestation
* PMH
* Family history/social history/schooling
* Systematic enquiry
* Dysmorphic features
* Systemic examination

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15
Q

summarise available assessment tools?

A
  • Height/ length/ weight
  • Growth Charts and plotting
  • MPH and Target centiles
  • Growth velocity
  • Bone age
  • Pubertal assessment
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16
Q

what is classed as ‘normal’ growth?

A

– Wide range within healthy population
– Different ethnic subgroups
– Inequality in basic health and nutrition
– Normality may relate to individuals or
populations (genetic influence)

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17
Q

what are factors that can influence height?

A
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18
Q

how is the shape of normal growth?

A

infantile
childhood
pubertal

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19
Q

what are hormones involved in puberty?

A
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20
Q

what is the relationship between growth and other changes in puberty in males and females?

A
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21
Q

what are the most important pubertal stages in a girl?

A

Breast budding (Tanner Stage B 2) in a girl

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22
Q

what are the most important pubertal stages in a boy?

A

Testicular enlargement (Tanner Stage G2 -T 3- 4 ml) in boy

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23
Q

what are the different growth patterns in a girl versus a boy?

A
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24
Q

what are implications of obesity for growth and puberty in girls?

A

Children who are obese put on weight much faster - little bit of growth acceleration
Tend to go into puberty earlier

End up same height at end of day
Obese children always tall grow well

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25
Q
A
25
Q
A
26
Q

what are indications for referral?

A

Extreme short or tall stature (off centiles)
* Height below target height
* Abnormal height velocity (crossing centiles)
* History of chronic disease
* Obvious dysmorphic syndrome
* Early/late puberty

27
Q

what are common causes of short stature?

A
  • Familial
  • Constitutional
  • SGA/IUGR
28
Q

what does the centile chart for familial short stature look like?

A
29
Q

what does the centile chart for constitutional short stature look like?

A
30
Q

what can be given if a patient is short for gestational age?

A

growth hormone

31
Q

what are pathaological causes of short stature?

A
  • Undernutrition
  • Chronic illness (JCA, IBD, Coeliac)
  • Iatrogenic (steroids)
  • Psychological and social
  • Hormonal (GHD, hypothyroidism)
  • Syndromes (Turner, P-W)
32
Q

describe the appearance of growth hormone deficiency?

A
33
Q

what is thyroid deficiency?

A

fallen several centriles iver number of years weight maintained but height reduced

34
Q

what are some examples of syndromes that may affect growth but benefit from GH?

A

glucocorticoid excess
turner syndrome
prader-willi syndrome
noonans syndrome
achrondroplasia

35
Q

what is classed as early and delayed puberty in a boy?

A

early < 9 years (rare)

delayed >14 (common, especially
CDGP)

36
Q

what is classed as early and delayed puberty in a girl?

A

– early <8 years

– delayed >13 (rare)

37
Q

Constitutional Delay of Growth
and Puberty (CDGP)?

A

Boys mainly
* Family history in dad or brothers
(difficult to obtain!)
* Bone age delay
* Need to exclude organic disease

38
Q

what are some other causes of delayed puberty?

A
  • Gonadal dysgenesis (Turner 45X,
    Klinefelter 47XXY)
  • Chronic disease (Crohn’s, asthma)
  • Impaired HPG axis (septo-optic dysplasia,
    craniopharyngioma, Kallman’s syndrome)
  • Peripheral (cryptorchidism, testicular
    irradiation)
39
Q

what can be reasons for early sexual development in girls?

A
40
Q

what is Central Precocious Puberty?

A
  • Pubertal development
    – Breast development in girls
    – Testicular enlargement in boys
  • Growth spurt
  • Advanced bone age
41
Q

Central Precocious Puberty investigations in girls versus boys?

A

Girls:
– Usually idiopathic
– Pituitary imaging

  • Boys:
    – Look for underlying cause, i.e. brain tumor?
42
Q

what is treatment for central precocious puberty?

A

– GnRH agonist

43
Q

what is Precocious Pseudopuberty?

A
  • Gonadotrophin independent
    (low/prepubertal levels of LH and FSH)
  • Abnormal sex steroid hormone secretion
  • Virilasing or feminasing
  • Clinical picture: secondary sexual
    characteristics
44
Q

what may make identifying the sex of a newborn baby difficult?

A

The newborn with ambiguous
genitalia

45
Q

what is the management approach for ambiguous genitalia?

A
  • Do not guess the sex of the baby!
  • Multidisciplinary approach (paed endo, surg,
    neonatologist, geneticist, psychologist)
  • Exam: gonads?/ internal organs
  • Karyotype
  • Exclude Congenital Adrenal Hyperplasia!-
    risk of adrenal crisis is first 2 weeks of life
46
Q

what is congenital hypothyroidism?

A
  • 1 in 4000 births
  • Causes:
    – Athyreosis/ hypoplastic/
    ectopic
    – Dyshormonogenic
  • Newborn screening
  • Start treatment within first
    2 weeks
47
Q

what is aquired hypothyroidism?

A
  • Most common cause: Autoimmune
    (Hashimoto’s) thyroiditis
  • Family history of thyroid/ autoimmune
    disorders
  • Childhood issues:
    – Lack of height gain
    – Pubertal delay (or precocity)
    – Poor school performance (but work steadily)
48
Q

what is thyroid deficiency?

A

fallen several centriles over number of years weight maintained but height reduced

49
Q

how prevalent is obesity in children?

A
  • Nearly a third (31%) of children aged 2–15
    are overweight or obese1
  • The direct cost of obesity to the NHS is
    estimated to be £4.2bn a year2
  • At Reception and Year 6, children in the
    poorest decile are almost twice as likely to
    be obese compared those in the most
    affluent decile3
50
Q

define overweight?

A

(BMI >85th centile or SD
>1.04)

51
Q

define obese?

A

(BMI >97.5th centile or SD >2)

52
Q

how is a child assessed for obesity?

A
  • Weight
  • Body mass index (BMI) (kg/m2
    )
  • Height
  • Waist circumference
  • Skin folds
  • History and examination
  • Complications
53
Q

what should be covered in the history for an obese patient?

A
  • Diet
  • Physical activity
  • Family history
  • Symptoms suggestive of
    – Syndrome
    – Hypothalamicpituitary pathology
    – Endocrinopathy
    – Diabetes
54
Q

what are complications of obesity?

A

 Metabolic syndrome
 Fatty liver disease (nonalcoholic steatohepatitis)
 Gallstones
 Reproductive dysfunction (eg, PCOS)
 Nutritional deficiencies
 Thromboembolic disease
 Pancreatitis
 Central hypoventilation
 Obstructive sleep apnea
 Gastroesophageal reflux disease
 Orthopaedic problems (slipped capital femoral epiphysis, tibia vara)
 Stress incontinence
 Injuries
 Psychological
 Left ventricular hypertrophy
 Atherosclerotic cardiovascular disease
 Right-sided heart failure

55
Q

what are causes of obesity?

A
  • SIMPLE OBESITY
  • Drugs
  • Syndromes
  • Endocrine disorders
  • Hypothalamic damage
56
Q

what drugs can cause obesity?

A
  • Insulin
  • Steroids
  • Antithyroid drugs
  • Sodium Valproate
57
Q

what syndromes can cause obesity?

A

 Prader Willi syndrome
 Laurence-Moon-Biedl syndrome
 Pseudohypoparathyroidism type 1
 Down’s syndrome

58
Q

what endocrine disorders can cause obesity?

A

 Hypothyroidism
 Growth hormone deficiency
 Glucocorticoid excess
 Hypothalamic lesion
(tumour/trauma/infection)
 Androgen excess
 Insulinoma
 Insulin resistance syndromes
 Leptin deficiency

59
Q

how is diabetes treated?

A
  • Diet
  • Exercise
  • Psychological input
  • Drugs???

Endocrine (35 decks)

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