Intro week-normal growth

Question 1

what is a epiphysis
how does it look on x ray
how does it change in puberty
what does a larger epiphysis mean

Answer 1

• growth plate at the end of long bones
• seen as dark line on x ray
• in puberty it undergoes chondrocyte proliferation, hypertrophy and calcification
• larger epiphysis=more room for growth

Question 2

reasons for advanced bone age

Answer 2

• Hormone excess may be due to tumour

- Or early puberty

Question 3

What are the stimulants of the growth plate/epiphysis? (5)

Answer 3

GH
IGF-1 (produced mainly by liver and stimulated by GH 
Thyroid
Oestrogen
 PTH

Question 4

What are the inhibitor of the growth plate/epiphysis?(4)

Answer 4

Cytokines
Drugs
High dose estrogen and steroids

Question 5

what is a Harpenden Stadiometer

Answer 5

measure height in children

Question 6

How would we expect children to grow, compared to their mid parental decile?

Answer 6

9/10 of there children to be within +/- 2 of predicted deciles (plot on graph then +/- 2 big lines)

Question 7

Height velocity equation?

Answer 7

Height difference/time difference

Question 8

What does adult height predictor predict?

Answer 8

4/5 children will be within +/- 6cm of predicted decile

Question 9

Possible causes of short stature? (6)

Answer 9

· Inherited/familial 
· Chromosomal-Turners (female)
· Nutrition 
· Hormonal 
· Phycological and emotional 
· Can present before disease manifests

Question 10

Endocrine causes of short stature?

Answer 10

· GH deficiency 
· Hypothyroidism 
· Delayed puberty 
· Cushing's disease (ACTH secreting pit adenoma)
· Cushing syndrome (usually iatrogenic)

Question 11

how might pathological obesity and nutritional obesity present different?

Answer 11

short and fat=pathological
tall and fat=nutritional
tall and thin=chronic disease

Question 12

What hormone stimulates puberty?

Answer 12

• Gonadotrophin releasing hormone (GnRH) from hypothalamus.

- This hormone stimulates the pituitary gland to release FSH and LH

Question 13

when are most GnRH released?

Answer 13

· Burst in foetus, then infantile, then puberty

Question 14

what are the differences in a child with delayed pubertal growth spurt VS early pubertal growth spurt?

Answer 14

· Delayed pubertal growth spurt: short stature but normal final height
Early pubertal growth spurt: tall stature but short final height

Question 15

what are the puberty TANNER stages in girls?

Answer 15

stage 1 PRE PUBERTAL
-no signs of pubertal development

stage 2/3 DURING PUBERTY
-any breast enlargement, pubic or axillary hair

stage 4 COMPLETING PUBERTY
-started periods, with signs of pubertal development

Question 16

what are the puberty TANNER stages in boys?

Answer 16

stage 1 PRE PUBERTAL
-High voice and no signs of pubertal development

stage 2/3 DURING PUBERTY
-Any of: 
    Deepening of voice
    Early pubic/axillary hair
    Testicular/ penis enlargement

stage 4 COMPLETING PUBERTY

• Voice broken
• Facial hair
• Adult size penis, pubic and axillary hair

Question 17

Whats the order of pubertal changes for girls?

Answer 17

· Puberty presents with breast budding (thelarche)
· Subsequent pubic and axillary hair development
· Menarche at end of puberty

Question 18

Whats the order of pubertal changes for boys?

Answer 18

· Pubertal onset marked by increase in testicular volumes

· Subsequent pubic and axillary hair development

Question 19

fastest height velocity for boys/girls?

Answer 19

·Girls peak HV mid-puberty (breast stage 3)

Boys-peak HV late puberty

Question 20

define precocious puberty for boys and girls

Answer 20

· Before age 8 girls (breast bud) and age 9 in boys

Question 21

define delayed puberty for boys and girls

Answer 21

· No puberty signs by 13 in girls and by 14 in boys

·No menarche at 15 years

Question 22

define concordant/central precocious puberty

Answer 22

Premature activation of hypothalamic axis, dependent non GnRH (normally idiopathic need to consider CNS abnormality)

Question 23

define virilisation

Answer 23

increased adrenal androgen secretion

Question 24

possible investigations for precocious puberty?

Answer 24

· Bone age 
· Thyroid function tests 
· Pituitary function tests 
· Oestradiol/testosterone 
· Adrenal scan 
· MRI 
· Karyotype

Question 25

What could pubertal arrest be a sign of?

Answer 25

CNS tumour (PROLACTINOMA)

Question 26

Failure to thrive investigations?

Answer 26

· FBC, UE, LFT, bone profile 
· Coeliac serology
· TFTs
· IGF-1 
· Karyotype

Question 27

size of testicals as puberty is starting?

Answer 27

4ml

Question 28

why do you scan adrenals in increased growth/early puberty

Answer 28

check for Congenital adrenal hyperplasia

Question 29

For growth chart measurements should you adjust for prematurity?

Answer 29

• Yes, if born <37/40 weeks

- plot corrected for 24 months