Paediatric endocrinology and diabetes Flashcards
Briefly describe how to measure height in a child
use a stadiometer
stand up straight with legs together, look forward with heels, buttocks and scapulae against wall
remove shoes and socks
straighten head and take deep breath in
be very accurate and read height to last complete mm
Why do we measure length in children?
cannot stand or walk
under 2
Why do we measure sitting height in children?
trunk in respect to limbs
body problems eg achondroplasia
How to measure head circumference in children
routine in children under 2
forehead to occipital prominence
What is the maximal circumference of the head?
forehead to occipital prominence
What shape do we use to plot on a graph?
dots - for accuracy
List some things found on the RCPCH UK 2-18 growth chart?
predicted adult height scale
parent height comparison
birth centiles
WHO standards until age 4
List some condition specific growth charts
downs syndrome
turners syndrome
boy/girl
What is the mid parental centile?
average adult height centile to be expected for all children of those parents
How do we do bone age?
TW 20 - 20 bones in hand
radiograph
Osteopenia
bone mineral density is lower than normal
How do we plot bone age?
on a graph using a triangle
plot chronological age on same graph
Assessment tools
Height/ length/ weight • Growth Charts and plotting • MPH and Target centiles • Growth velocity • Bone age • Pubertal assessment
List the letters used in tanner staging of puberty and the numbers
B 1-5 G 1-5 PH 1-5 AH 1-3 T 2ml - 20ml
What do the number in tanner staging mean?
1 = pre pubertal 2 = start of puberty 5 = adult
What is used to measure testicular volume?
prader orchidometer
Why is a precise definition of normal growth difficult?
wide range in healthy population ethnic subgroups inequality in basic health and nutrition normality to individuals and populations genetics
List some factors which influence height
sex, race, nutrition, chronic disease, emotional status, parental height, bone age, puberty, general health, specific growth disorders, socio-economic status
Describe briefly the increase in height per year in infancy, childhood and puberty
I - very rapid
C - constant
P - large peak - girls earlier
What are the types of hormones involved in puberty?
sex and growth
List the chronological pubertal changes in boys
testicular growth, penile growth, facial hair
List the chronological pubertal changes in girls
breast bud, breast development, menstruation
What stage in tanner is breast budding?
B2
What stage in tanner is testicular enlargement?
G2
T 3-4 ml
Earliest objective signs of puberty in boys and girls
breast bud
testicular enlargement
What does obesity do to height and puberty?
make you tall
stimulate puberty
obese and small is worrying
List some indications for referral for growth disorders
extreme tall or short - off centiles height below target height abnormal height velocity - cross centiles history of chronic disease obvious dysmorphic syndrome early/late puberty
3 common causes of short stature
SGA/IUGR
familial
constitutional
What do SGA babies benefit from?
growth hormone
What is constitutional growth?
period of delayed growth
List some pathological causes of short stature
undernutrition chronic illness eg IBD iatrogenic eg steroids psychological and social eg in care hormonal eg GHD, hypothyroidism syndromes eg turner, noonans
Early and delayed puberty in boys
early <9 = rare
delayed >14 - common, especially CDGP
Early and delayed puberty in girls
early <8
delayed >13 rare
Constitutional delay in growth and puberty
mainly boys
FH - hard to obtain
bone age delay
exclude organic disease
List some other causes of delayed puberty
gonadal dysgenesis
chronic disease
impaired HPG axis
peripheral eg testicular irradiation
Thelarce
onset of female breast development
precocious
developed earlier than usual
adrenarche
early sexual maturation - adrenals
menarche
menstruation
What is central precious puberty and describe it
early onset of breast and testicular development
growth spurt and advanced bone age
central precocious puberty: worrying for boys or girls?
boys
girls - normal, pituitary imaging
boys - underlying cause eg brain tumour
Treatment of central precocious puberty
GnRH agonist
What is precocious pseudopuberty?
gonadotrophin independent - low hormone levels
abnormal sex steroid secretion
secondary sexual characteristics
How to manage ambiguous genitalia in newborn
do not guess
karyotype
MDT, exam of genitalia and internal
What should you exclude in newborns with ambiguous genitalia?
congenital adrenal hyperplasia
Management of congenital hypothyroidism and causes
hypoplastic, dyshormogenic
screen and start treatment within 2 weeks
Causes and consequence of acquired hypothyroidism
autoimmune
FH
lack of height gain, pubertal delay and poor school performance
How to assess an obese child
BMI, height, weight
skin folds, waist circumference, history, exam, complications
Causes of child obesity
simple drugs eg insulin, CCS, sodium valproate syndromes endocrine disorders eg GHD, hypothyroidism, leptin deficiency hypothalamic damage
Treatment of obesity
exercise
diet
psychological
drugs??
Syndromes causing obesity
PW, downs
4 T’s of type 1 diabetes
thirst
thinner
toilet
tired
Testing for type 1 diabetes and DKA
skin prick capillary glucose
>11mM
What do you do for child with type 1 diabetes with DKA?
same day review
red flag for type 1 DKA
wetting bed
under 5 signs/symptoms of type 1 diabetes
heavy nappies
irritable
recurring skin infections
blurred vision
DKA symptoms
nausea and vomiting coma drowsiness acetone breath abdominal pain deep, rapid respiration
