Paediatric Endocrinology and Diabetes Flashcards
What are some measurement techniques?
Height, length (under 2s), head circumference, sitting height, and plotted on growth charts (centile)
Target height and mid parental height
Describe bone age
TW 20
Radiographs of high quality and skilled practitioner needed
Pathological conditions can distort bones
Describe puberty staging
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
What is used to measure testicular maturation?
Prader Orchidometer
What is a summary of assessment tools?
Hight/ weight/ length
Growth charts and plotting
MPH and target centiles
Growth velocity
Bone age
Pubertal assessment
What are some factors influencing height?
Age, sex, race, nutrition, parental heights, puberty, skeletal maturity, general health, chronic disease, socio-economic status and emotional well being
What are the 3 stages of growth?
Infantile
Childhood
Pubertal
What hormones act on the gonads?
LH and FSH
GnRh acts on pituitary from hypothalamus
Describe the relationship between height and puberty
Boys - onset of testicular growth happens first then height starts, facial hair is last
Girls - height and breast budding start and menarche is last
What are the most important pubertal stages?
Breast budding - stage 2
Testicular enlargement - G2 and T 3-4ml
Early signs of puberty and when these present then puberty progresses onwards usually
What are indication for growth disorders and indication for referral?
Extreme short or tall stature
Height below target
Abnormal height velocity
History of chronic illness
Early/ late puberty
What are some common causes of short stature?
Familial, constitutional and small gestational age
What is constitutional delay of growth and puberty?
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
What are pathological causes of short stature?
Undernutrition
Chronic illness
iatrogenic - steroids
Psychological and social
Hormonal - GH and hypothyroidism
Syndromes - Turners
What is achondroplasia?
Skeletal dysplasia and shirt limbs
What is early and delayed puberty for boys?
Early is under 9 years
Delayed is over 14
What is early and delayed puberty for girls?
Early is over 8 years
Delayed is more than 13 years
What are some other causes for delayed puberty?
Gonadal dysgenesis
Chronic disease
Impaired HPG axis
Peripheral - cryptorchidism and testicular irradiation
What are some signs of early sexual development?
Breast development - infantile thelarche, thelarche variant and true central precocious puberty
Secondary sexual characteristics - exaggerated adrenarche and precocious pseudo puberty
What is central precocious puberty?
More common in girls
Breast development in girls and testicular enlargement in boys
Growth spurt
Advanced bone age
What is the cause and treatment for central precocious puberty?
Girls is usually idiopathic but may need pituitary imaging
Boys - look for underlying cause
GnRH agonist
Describe precocious pseudo-puberty
Gonadotrophin independent - low-prepubertal levels of LH and FSH
Abnormal sex steroid hormone secretion
Virilising or feminising
Secondary sexual characteristics
What is the management for ambiguous genitalia?
Do not guess
MDT approach
Exam - internal organs and gonads
Karyotype
Exclude congenital adrenal hyperplasia - risk of adrenal crisis in first 2 weeks
Describe congenital hypothyroidism
1 in 4000 births
Causes - athyreosis/ hypoplastic/ ectopic and dyshormonogenic
Newborn screening
Start treatment within first 2 weeks
What are the causes of acquired hypothyroidism?
Most common - autoimmune thyroiditis - Hashimoto’s
FH of thyroid and autoimmune
What are the childhood issues seen in acquired hypothyroidism?
Lack of height gain
Pubertal delay
Poor school performance
Usually flat face appearance and little weight gain
What are the definitions of overweight and obesity in children?
BMI > 85th centile
BMI > 97.5th centile
Varies by age on graph unlike adults
How is obesity assessed?
Weight, BMI, height, waist circumference, skin folds, history and exam, and complications
What is abnormal for children?
Obese and short
What is asked in history for obesity?
Diet, physical activity and FH
What are some complications of obesity?
Metabolic syndromes, fatty lover disease, gallstones, PCOS, nutrition deficiency, pancreatitis, heart failure and orthopaedic problems
What are the causes for obesity in children?
Simple obesity
Drugs
Syndrome
Endocrine disorders
Hypothalamic damage
What is simple obesity?
Increased intake and decreased activity
What drugs could cause obesity?
Insulin
Steroids
Anti-thyroid drugs
Sodium valproate
What syndromes may cause obesity?
Prada Willi
Laurence Moon Biedl
Pseudo-hypothyroidism type I
Down’s
What endocrine disorders can cause obesity?
Hypothyroidism, GH deficiency, glucocorticoids EX, hypothalamic lesion, androgen EX, insulinoma and insulin resistance syndromes
