Lecture Day 1 Developmental Assessment

Question 1

Phases of rapid growth

Answer 1

1-2 years: thyroid, nutrition & love

Puberty: oestrogen & testosterone

Question 2

Where and how do we grow

Answer 2

Growth plates: epiphysis: bone cells become calcified and cartilaginous.
Examine under X-Ray (Bone age)

Question 3

How do you measure growth what are you comparing the measurements to.

Answer 3

Measure height (standing in Frankfurt plain from > 2) on harpenden stadiometer + head circumference 
- Weight: BMI

Compare

• previous measurements
• population (centiles)
• parental heights

Question 4

Head too big?

Answer 4

Hydrocephalus

Question 5

What is the correct to plot measurement on growth chart. What if they are pre-term

Answer 5

Dots

If pre-term (<37 weeks) plot correct the their gestation age

Question 6

What is a Mid parental centile?

Answer 6

plot parents height (make sure they are their biological parents, be discreet)

• girl: fathers height - 14cm
• boy: Mothers height + 14cm

Connect lines to give mid-parental centile
9/10 within +/- 1 - 2 centimes

If large discrepancy consider growth disorder.

Question 7

What bone do we X-ray to measure bone age.

Answer 7

X-ray wrist & hand

Question 8

What is Height velocity?

Average growth per year

Answer 8

speed of growth reflects the child’s state at any particular time.
4-6cm per year

Question 9

What makes child growth too slowly

Answer 9

malnourishment
•Inhertied/familial
• Chromosomal abnormality: turners (only girls).
• Nutrition 
• Hormonal: thyroid, growth hormone, 
• Inflammatory bowel
• Psychological & emotional 
• Chronic disorder: brittle bones, severe asthma

Question 10

Differences of growth at puberty between gals and boys

Answer 10

Greater male growth prior to puberty (+1.6cm)
Puberty is later (+6.4)
Puberty growth is greater (+6.0cm)

Question 11

Endocrine abnormalities that effect growth

What do endocrine children look like?

Answer 11

• hypothyroidism
• Growth hormone deficiency
• Cushing’s Disease (ACTH secreting pit adenoma)
• Cushing syndrome (usually iatrogenic from steroid in inflammatory conditions)
  delayed puberty

Short & fat! Not tall

Question 12

First features of puberty

Answer 12

Boys:
- Testicular size enlargement

Girls:
- Breast development (budding)

Question 13

What hormone initiates puberty

Answer 13

GnRH (look at graph), triggers LH, FSH triggering oestrogen (overies) androgens (adrenals) and testosterone (testies) which causes breast development, sexual hair, genital enlargement

Question 14

What is adrenarche?

Answer 14

Adrenal glands excreting increased levels of androgens (10-11 years).

Question 15

Stages of puberty (Tanner)

Answer 15

Girls
Stage 1: No signs
Stage 2-3: Any breast development, pubic or axillary hair
Stage 4-5: started peroids, with signs of developmental development

Boys
Stage 1: high voice & no signs of puberty
Stage 2: deepening voice, hair, testies,
Stage 3: any of: voice broken, facial hair, adult size penis

Question 16

Last stage of puberty in girls

Answer 16

Periods (Menarches)

Question 17

When peak growth during puberty

Answer 17

• girls: late puberty

- boys: middle of periods

Question 18

Measuring boys testies

Answer 18

Prader Orchidometer

- 4 = puberty

Question 19

What is precocious puberty

Answer 19

Onset of secondary sexual characteristic

• before 8 in girls
• before 9 in boys

Question 20

What is the difference of central and peripheral precocious puberty

Answer 20

Central: premature activation of hypothalamic axis. Can be idiopathic or consider CNS abnormality

Discourdant: source of sex steroids not under gonadotrophin

• Virilisation: ↑ adrenal androgen secretion
• Premature thelarche: isolated breast development

Question 21

What is delayed puberty

Answer 21

Girls > 13

Boys > 14

Question 22

Causes

Answer 22

1. Central (low LH/FSH): constitutional delay, chronic disease, poor nutrition, pituaity problem
Hypothalamic hypogonadism (nutrition, chronic disease, CNS tumour)

2. Peripheral (high LF/FSH)
Testicular/ovarian damage or underdevelopment 
Hypergondotrophic hypogonadism (Klinefelters, Turners, cyrptochidism)

Most common cause is constitutional delay. M:F 7:1. In girls exclude Turners

Question 23

Baseline investigations

Answer 23

Bone age
Karyotype
Coelic screen
FBC, UE
TFTs
LH/FSH/Oestrogen/testosterone 
Consider imagine: MRI/Pelvic USS

Question 24

How would Turners be diagnosed?

Answer 24

Karyotype 45X
FSH ↑: gonadal failure

Associated features:

• Short
• ↓ development amenorrhoea
• ↑ BP
• Cardiac (aortic stenosis or coarctation) Need ECHO

Question 25

Subsequent investigations for Turner

Answer 25

BP
ECHO
Renal/pelvic USS
TFT
Hearing Test
Coeliac screen

Question 26

If weight problem alongside height what is the cause?

Answer 26

Malnutrition

Question 27

Possible tests for precocious puberty

Answer 27

bone age 
TFTs
Oestradiol/testosterone 
pituitary function test
scan pelvis & adrenals 
MRI