Paediatric Endocrinology

Question 1

how would you see obesity in children?

Answer 1

bmi at 91st centile or above - tailored clinical intervention needed

is 98th centile or above: assess for comorbidities

Question 2

cause of obesity in kids

Answer 2

lifestyle

asian kids: 4 times more than white

female

taller : usually obese kids above 50th percentile in height

Question 3

causes of obesity in kids

Answer 3

GH deficiency
hypothyroidism
downs
cushings sundrome
prader-willi syndrome

Question 4

consequences of obesity in kids

Answer 4

orthopaedic problems: slipped upper femoral epiphyses, blounts disease (development abnormality of tibia = bowing of legs) , msk pains

sleep apnoea

benign intracranial hypertension

long term: t2dm , htn, ihd

psychological: poor self esteem, bullying

Question 5

What is testicular torsion?

mc

Answer 5

twist of spermatic cord = testicular ischaemia and necrosis.

delay can cause isch and nec. - subfertility and infertility

male age between 10 and 30 - peak incidence 13-15

Question 6

features of testicular torsion

Answer 6

severe pain and sudden onset unilateral

pain can refer to lower abdomen

n+v

Question 7

on examination what would you see for testicular torsion

Answer 7

swollen tender testis retracted upwards.

cremasteric reflex lost

skin reddened

elevation of testis doesnt ease pain - PREHN’S SIGN

firm swollen testicle
abnormal testicular lie - often horizontal.

rotation: epididymis not in normal posterior position

Question 8

how would you manage testicular torsion?

Answer 8

tx with urgent surgical exploration of scrotum

if torted testis is found - both testis should be fixed as bell clapper testis is often bilateral

nil by mouth before surgery

orchiopexy - correct position of testis and fix in place

orchidectomy - remove testicle is delayed or necrosis

Question 9

explain bell clapper deformity briefly?

Answer 9

normally testicle is fixed posterior to tunica vaginalis.

bell clapper is where it isnt there and testicle hangs in horizantal not vertical.

can rotate and then twist at spermatic cord.

twists and cuts off blood supply

Question 10

how to diagnose testicular torsion?

Answer 10

scrotal uss - whirlpool sign - spiral appearance to spermatic cord and blood vessels

Question 11

complications of undescended testis

Answer 11

infertility

torsion

testicular cancer

psychological

Question 12

how would you manage undescended testis

Answer 12

review at 3months of age. - see urological surgeon by 6 months

orchidopexy: 1 yrs

bilateral undescended testes: few with senior paeds within 24 hrs - may nee durgent endo or genetic investigation

Question 13

rf for undescended testes

Answer 13

fhx

low birth weight

small for gestational age

prematurity

maternal smoking during pregnancy

Question 14

explain retractile testes

Answer 14

when boys not reached puberty, testes move out of scrotum into inguinal canal or when its cold.

or cremasteric reflex activated.

resolves as they go through puberty and testes settle in scrotum.

may fully retract or fail to descend - surgical correct orchidopexy

Question 15

what is precocious puberty?

Answer 15

development of secondary sexual characteristics before 8 in girls and 9 in men

more in women

males - uncommon, organic cause

women - idiopathic or familial and follows normal sequence of puberty

Question 16

other terms associated with precocious puberty

Answer 16

thelarche - 1st stage of breast development

adrenarche - 1st stage of pubic hair development

Question 17

classifying precocious puberty into

gonadotrophin dependent

and gonoadotrophin independent

Answer 17

gonadotrophin dependent - central - true

• due to premature activation of hypothalamic-pituitary-gonadal axis
  -fsh and lh high

gonadotrophin independent - pseduo , false
- due to excess sex hormones
-fsh and lh low

Question 18

what do you see in testes in precocious puberty

and why would that be a possibility

there 3!!

Answer 18

bilateral enlargement = gonadotrophin release from intracranial lesion

unilateral enlargement= gonadal tumour

small testes = adrenal cause = tumour or adrenal hyperplasia

Question 19

organic causes of precocious puberty - girls

Answer 19

rare
rapid onset, neurological sx and signs and dissonance (mismatch in physical/emotional development)

eg mccune albright syndrome

Question 20

what is kallmann’s syndrome?

genetic

and why it happens?

Answer 20

cause of delayed puberty secondary to hypogonadotropic hypogonadism.

xlinked recessive.

failure of GnRH- secreting neurones to migrate to hypothalamus

Question 21

what clue in questions for kallmans syndrome

Answer 21

lack of smell - anosmia in a boy with delayed puberty

Question 22

features of kallmans syndrome

Answer 22

delayed puberty
hypogonadism, cryptorchidism

anosmia

sex hormone levels low

lh fsh inapproprately low/normal

pts typically of normal or above average height

cleft lip/palate and visual hearing defects in some pts

Question 23

how would you manage kallmanns syndrome

Answer 23

testosterone supplementation

gonadotrophin supplementation - may give sperm production if fertility is desired later in life