Paediatric Endocrinology and Diabetes

Question 1

What are some measurement techniques?

Answer 1

Height, length (under 2s), head circumference, sitting height, and plotted on growth charts (centile)
Target height and mid parental height

Question 2

Describe bone age

Answer 2

TW 20
Radiographs of high quality and skilled practitioner needed
Pathological conditions can distort bones

Question 3

Describe puberty staging

Answer 3

Tanner method
B 1-5 - breast development
G 1-5 genital development
PH 1-5 pubic hair
AH 1-3 axillary hair
T 2ml to 20 ml testosterone
Stage 1 is pre puberty and 2 is started

Question 4

What is used to measure testicular maturation?

Answer 4

Prader Orchidometer

Question 5

What is a summary of assessment tools?

Answer 5

Hight/ weight/ length
Growth charts and plotting
MPH and target centiles
Growth velocity
Bone age
Pubertal assessment

Question 6

What are some factors influencing height?

Answer 6

Age, sex, race, nutrition, parental heights, puberty, skeletal maturity, general health, chronic disease, socio-economic status and emotional well being

Question 7

What are the 3 stages of growth?

Answer 7

Infantile
Childhood
Pubertal

Question 8

What hormones act on the gonads?

Answer 8

LH and FSH
GnRh acts on pituitary from hypothalamus

Question 9

Describe the relationship between height and puberty

Answer 9

Boys - onset of testicular growth happens first then height starts, facial hair is last
Girls - height and breast budding start and menarche is last

Question 10

What are the most important pubertal stages?

Answer 10

Breast budding - stage 2
Testicular enlargement - G2 and T 3-4ml
Early signs of puberty and when these present then puberty progresses onwards usually

Question 11

What are indication for growth disorders and indication for referral?

Answer 11

Extreme short or tall stature
Height below target
Abnormal height velocity
History of chronic illness
Early/ late puberty

Question 12

What are some common causes of short stature?

Answer 12

Familial, constitutional and small gestational age

Question 13

What is constitutional delay of growth and puberty?

Answer 13

Growing steadily but small so gap in growth chart
Puberty then catches up - sometimes needs small push like testosterone given
Boys mainly and usually FH
Bone age delay

Question 14

What are pathological causes of short stature?

Answer 14

Undernutrition
Chronic illness
iatrogenic - steroids
Psychological and social
Hormonal - GH and hypothyroidism
Syndromes - Turners

Question 15

What is achondroplasia?

Answer 15

Skeletal dysplasia and shirt limbs

Question 16

What is early and delayed puberty for boys?

Answer 16

Early is under 9 years
Delayed is over 14

Question 17

What is early and delayed puberty for girls?

Answer 17

Early is over 8 years
Delayed is more than 13 years

Question 18

What are some other causes for delayed puberty?

Answer 18

Gonadal dysgenesis
Chronic disease
Impaired HPG axis
Peripheral - cryptorchidism and testicular irradiation

Question 19

What are some signs of early sexual development?

Answer 19

Breast development - infantile thelarche, thelarche variant and true central precocious puberty
Secondary sexual characteristics - exaggerated adrenarche and precocious pseudo puberty

Question 20

What is central precocious puberty?

Answer 20

More common in girls
Breast development in girls and testicular enlargement in boys
Growth spurt
Advanced bone age

Question 21

What is the cause and treatment for central precocious puberty?

Answer 21

Girls is usually idiopathic but may need pituitary imaging
Boys - look for underlying cause
GnRH agonist

Question 22

Describe precocious pseudo-puberty

Answer 22

Gonadotrophin independent - low-prepubertal levels of LH and FSH
Abnormal sex steroid hormone secretion
Virilising or feminising
Secondary sexual characteristics

Question 23

What is the management for ambiguous genitalia?

Answer 23

Do not guess
MDT approach
Exam - internal organs and gonads
Karyotype
Exclude congenital adrenal hyperplasia - risk of adrenal crisis in first 2 weeks

Question 24

Describe congenital hypothyroidism

Answer 24

1 in 4000 births
Causes - athyreosis/ hypoplastic/ ectopic and dyshormonogenic
Newborn screening
Start treatment within first 2 weeks

Question 25

What are the causes of acquired hypothyroidism?

Answer 25

Most common - autoimmune thyroiditis - Hashimoto’s
FH of thyroid and autoimmune

Question 26

What are the childhood issues seen in acquired hypothyroidism?

Answer 26

Lack of height gain
Pubertal delay
Poor school performance
Usually flat face appearance and little weight gain

Question 27

What are the definitions of overweight and obesity in children?

Answer 27

BMI > 85th centile
BMI > 97.5th centile
Varies by age on graph unlike adults

Question 28

How is obesity assessed?

Answer 28

Weight, BMI, height, waist circumference, skin folds, history and exam, and complications

Question 29

What is abnormal for children?

Answer 29

Obese and short

Question 30

What is asked in history for obesity?

Answer 30

Diet, physical activity and FH

Question 31

What are some complications of obesity?

Answer 31

Metabolic syndromes, fatty lover disease, gallstones, PCOS, nutrition deficiency, pancreatitis, heart failure and orthopaedic problems

Question 32

What are the causes for obesity in children?

Answer 32

Simple obesity
Drugs
Syndrome
Endocrine disorders
Hypothalamic damage

Question 33

What is simple obesity?

Answer 33

Increased intake and decreased activity

Question 34

What drugs could cause obesity?

Answer 34

Insulin
Steroids
Anti-thyroid drugs
Sodium valproate

Question 35

What syndromes may cause obesity?

Answer 35

Prada Willi
Laurence Moon Biedl
Pseudo-hypothyroidism type I
Down’s

Question 36

What endocrine disorders can cause obesity?

Answer 36

Hypothyroidism, GH deficiency, glucocorticoids EX, hypothalamic lesion, androgen EX, insulinoma and insulin resistance syndromes