Paediatric Endocrinology and Diabetes Flashcards
What are the measurement techniques used to assess normal growth and pubertal development?
Height
Length (babies)
Sitting height
Head circumference
What factors can influence height?
Age Sex General health Puberty Skeletal maturity Specific growth disorders Parental heights Nutrition
What are the indications for referral of growth disorders?
Extreme short or tall statures Height below target height Abnormal height velocity (crossing centiles) History of chronic disease Obvious dysmorphic system Early/late puberty
What are common causes for short stature?
Familial
Constitutional
Small for gestational age
What are the pathological causes of short stature?
Undernutrition Iatrogenic (steroids) Chronic illness (JCA, IBD, coeliac) Hormonal (GHD, hypothyroidism) Syndromes (Turner, Prader-Willi, Noonan's) Psychological and social
What does GHD stand for?
Growth hormone deficiency
What are the general ranges for puberty in boys?
<9 yrs (early) >14 yrs (delayed)
What are the general ranges for puberty in girls?
<8 yrs (early) >13 (delayed)
What does SGA stand for?
Small for gestational age
What is the most important pubertal stage for girls?
B2
What is the most important pubertal stage for boys?
T3-4 ml
What are some of the causes of delayed puberty?
Gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
Chronic disease (Crohn’s, asthma)
Impaired HPG axis
Peripheral (cryptorchidism, testicular irradiation)
What are the clinical signs of central precocious puberty?
Pubertal development
Growth spurt
Advanced bone age
What is the treatment for central precocious puberty?
GnRH agonist
What are the clinical signs of precocious pseudopuberty?
Abnormal sex steroid hormone secretion
Gonadotrophin independent (Low levels of LH and FSH)
Viralising or feminasing
What is the management approach for ambiguous genitalia?
Karyotype
Examination of gonads and internal organs
Exclude congenital adrenal hyperplasia
What are the causes of congenital hypothyroidism?
Athyreosis/hypoplastic/ectopic
Dyshormonogenic
What is the most common cause of acquired hypothyroidism?
Autoimmune (Hashimoto’s) thyroiditis
What are the childhood issues associated with acquired hypothyroidism?
Lack of height gain
Pubertal delay or precocity
Poor school performance
What is the definition of overweight?
BMI> 85th centile or SD>1.04
What is the definition of obese?
BMI> 97.5th centile or SD>2
What are the main causes if obesity?
Drugs
Syndromes
Endocrine disorders
Hypothalamic damage
What drugs can be associated with obesity?
Insulin
Steroids
Antithyroid drugs
Sodium valproate
What syndromes are associated with obesity?
Prader Willi syndrome
Laurence-Moon-Niedl syndrome
Down’s syndrome
Pseudohypoparathyroidism type 1
What endocrine disorders are associated with obesity?
Hypothyroidism Growth hormone deficiency Glucocorticoid excess Hypothalamic lesion Androgen excess Leptin deficiency
What is the treatment for obesity?
Diet
Exercise
Psychological input
Drugs
What are the symptoms of childhood diabetes?
Thirsty Thinner Tired Use of toilet more often Return to bed wetting Constipation Blurred vision Behavioural changes
What is an immediate test for childhood diabetes?
Finger prick capillary glucose test >11mmol/L
What are the symptoms of diabetic ketoacidosis?
Nausea and vomiting Abdominal pain Sweet smelling "ketotic" breath Drowsiness Rapid, deep "sighing" respiration Coma
What is the test for diabetic ketoacidosis?
Finger prick glucose test >11mmol/L
