Lecture 3: Pediatric Endocrine Flashcards
What is considered an underweight BMI for the 2-18 y/o age group?
BMI <5th percentile for age
What is considered a normal weight BMI for the 2-18 y/o age group?
BMI ≥5th to <85th percentile for age
What is considered an overweight BMI for the 2-18 y/o age group?
BMI ≥85th to <95th percentile for age
What is considered an obese BMI for the 2-18 y/o age group?
BMI ≥95th percentile
What is considered severly obese class II and class III for those 2-18 y/o?
- Class II = ≥120 percent of the 95th percentile or a BMI ≥35 (whichever is lower)
- Class III= ≥140 percent of the 95th percentile or a BMI ≥40 (whichever is lower)
What is the normal growth velocity for school age children (6 y/o to puberty)?
≥5 cm/year (2 inches)
When a childs weight falls off first (or more dramatically) what should you be thinking about first as an underlying cause?
- Nutrition
- Not enough food (emesis, no food)
- Not enough absorbed (mal-absorptive conditions)
- Higher than average caloric requirements
When a childs height falls off first (or more dramatically) what should you be thinking about first as an underlying cause?
- Think endocrine
- GH deficiency
- Hypothyroidism
- Cushing’s syndrome
When a childs head circumference falls off first (or more dramatically) what should you be thinking about first as an underlying cause?
- Primary failure of the brain to grow
- Severe craniosynostosis
What is meant by “delayed bone age” in a child?
Bone age that is two standard deviations below the chronological age is considered delayed
What is essential in developing the differential diagnosis and guiding the work-up for abnormal growth in a child?
Comprehensive history and physical
Which growth curve charts can be used for a patient older than 24 months and how do they differ in terms of how a child is measured?
- If <36 months of age and using 0-36 month curve, measure length while child is supine (length)
- If older than 24 months, MAY use the 2-20 y/o chart but the height must be measured standing up (stature)
What is “catch-up” or “catch-down” growth and when does it occur during a childs development?
- Occurs in first 18 months of life
- Some kids make up to a 25% downward correction on the growth curve —> often occurs as more table food is introduced
- Some kids make up to a 25% upward correction on the growth curve
What is the definition of short stature in a child?
- Height 2 standard deviations below the mean height for age and sex (<3rd %tile)
- Height more than 2 standard deviations below the mid-parental height
What is the importance of Insulin-like Growth Factor (IGF-1) and IGF binding protein 3 (IGFBP3) in the work-up of short stature?
Can point to GH deficiency
With delayed puberty/short stature in females must always check what?
Karyotype for Turner Syndrome
Can short stature occur in the absence of other clinical features?
YES
What is the definition of precocious puberty in both boys and girls?
Full activation of the HPG axis before 8 years old in girls and before 9 years old in boys
Precocious puberty should be considered a diagnosis in a girl with what characteristics?
- Progressive breast development
- Crossing major percentile lines upward on the linear growth chart
Precocious puberty should be considered a diagnosis in a boys with what characteristics?
- Evidence of both testicular and penile enlargement
- Crossing major percentile lines upward on the linear growth chart
