Paediatric Endocrinology Flashcards
how would you see obesity in children?
bmi at 91st centile or above - tailored clinical intervention needed
is 98th centile or above: assess for comorbidities
cause of obesity in kids
lifestyle
asian kids: 4 times more than white
female
taller : usually obese kids above 50th percentile in height
causes of obesity in kids
GH deficiency
hypothyroidism
downs
cushings sundrome
prader-willi syndrome
consequences of obesity in kids
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
What is testicular torsion?
mc
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
features of testicular torsion
severe pain and sudden onset unilateral
pain can refer to lower abdomen
n+v
on examination what would you see for testicular torsion
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
how would you manage testicular torsion?
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
explain bell clapper deformity briefly?
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
how to diagnose testicular torsion?
scrotal uss - whirlpool sign - spiral appearance to spermatic cord and blood vessels
complications of undescended testis
infertility
torsion
testicular cancer
psychological
how would you manage undescended testis
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
rf for undescended testes
fhx
low birth weight
small for gestational age
prematurity
maternal smoking during pregnancy
explain retractile testes
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
what is precocious puberty?
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
other terms associated with precocious puberty
thelarche - 1st stage of breast development
adrenarche - 1st stage of pubic hair development
classifying precocious puberty into
gonadotrophin dependent
and gonoadotrophin independent
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
what do you see in testes in precocious puberty
and why would that be a possibility
there 3!!
bilateral enlargement = gonadotrophin release from intracranial lesion
unilateral enlargement= gonadal tumour
small testes = adrenal cause = tumour or adrenal hyperplasia
organic causes of precocious puberty - girls
rare
rapid onset, neurological sx and signs and dissonance (mismatch in physical/emotional development)
eg mccune albright syndrome
what is kallmann’s syndrome?
genetic
and why it happens?
cause of delayed puberty secondary to hypogonadotropic hypogonadism.
xlinked recessive.
failure of GnRH- secreting neurones to migrate to hypothalamus
what clue in questions for kallmans syndrome
lack of smell - anosmia in a boy with delayed puberty
features of kallmans syndrome
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
how would you manage kallmanns syndrome
testosterone supplementation
gonadotrophin supplementation - may give sperm production if fertility is desired later in life
