Paediatric Endocrinology and Diabetes Flashcards
What are relevant measurements to measure growth?
Height (supine measurement necessary in patients who are up to 2 years of age or are unable to stand)
Sitting height (gains appreciation of trunk length vs leg length)
Head circumference (routine in children that are less than 2 years old)
Weight
What time of the day should you plot a growth chart?
Try and plot roughly at the same time of day for each patient
What are the different types of centile charts?
Vary for:
- Different ethnic origin
- Different health and nutrition
- Different environmental and geographical setting
- Condition specific charts exist for certain conditions (e.g downs syndrome and turners syndrome)
How is the midparental height obtained for a boy and a girl?
Average height between mother and father
THEN
Boy: add 7cm to the total
Girl: subtract 7cm from the total
What is the range for normal height in a boy and a girl?
Boy +/- 10 cm of MPH (mid-parental height)
Girl +/- 8.5 cm of MPH (mid-parental height)
What is the purpose of obtaining bone age?
To assess the amount of growth that has taken place and how much there is left to go
Indicates skeletal maturation in normal children
ASSESSMENT TOOL NOT DIAGNOSTIC
What are the limitations of bone age?
Evaluation is needed by a skilled practitioner
Radiographs must be of high quality
Pathological conditions can distort bones
Severe ostopenia can confuse interpretation
Define ostopenia
a medical condition in which the protein and mineral content of bone tissue is reduced, but less severely than in osteoporosis.
What are the potential causes of reduced bone age?
Constitutional delay in growth
GH deficiency
Hypothyroidism
Malnutrition / chronic illness
What are the causes of advanced bone age?
Tall stature
Premature adrenarche
Overweight
Early puberty
Congenital adrenal hyperplasia
Overgrowth syndromes
What do the terms adrenarch, thelarche, pubarche and menarche mean?
Thelarche is the onset of female breast development.
Pubarche is the appearance of sexual hair.
Adrenarche is the onset of androgen-dependent body changes such as growth of axillary and pubic hair, body odor, and acne.
Menarche is the onset of menstruation.
What are blood hormone levels in children compared against?
Investigations of pituitary - gonadal axis in delayed puberty should be evaluated according to bone age rather than chronological age (for example, we should not expect pubertal values of LH and FSH in a child with bone age less than 12 yrs)
Define Precocious puberty
Precocious puberty is when a child’s body begins changing into that of an adult (puberty) too soon. Puberty that begins before age 8 in girls and before age 9 in boys is considered precocious puberty.
What are the tanner steges of puberty?
B - 1 to 5 (breast development)
G - 1 to 5 (genital development)
PH - 1 to 5 (pubic hair)
AH - 1 to 3 (axillary hair)
T - 2ml to 20 ml (testicles) - measured by orchidometer
What may small testes indicate?
Primary or secondary hypogonadism
What may large testes (macrochidism) be a sign of?
Fragile X syndrome
Why are normal patterns of growth useful for us?
Normal growth is a reflection of overall health and nutritional status. Understanding the normal patterns of growth enables the early detection of pathologic deviations (eg, poor weight gain due to a metabolic disorder, short stature due to inflammatory bowel disease) and can prevent the unnecessary evaluation of children with acceptable normal variations in growth
What are the relevant areas that are needed to investigate abnormal growth?
- Birth weight and gestation (birth weight has little effect on childhood height unless small for gestational age)
- PMH - look for any history of disease that may cause a reduction in height (Crohn’s disease and chronic renal failure)
- Family history/social history/schooling
(Socio - economic status - children from affluent areas, are, on average, taller than children from poor areas
Psycho - social deprivation - can cause profound gro wth retardation)
- Systematic enquiry
- Dysmorphic features
- Systemic examination
What are the factors that affect growth?
Age and Skeletal Maturity (bone age)
Sex - boys are slightly taller than girl s before puberty
Race - e.g. Scandinavians are tall, Oriental races are short
Nutrition - particularly important prenatally and in infancy. Contributes to height differences between races
Birth weight - little effect on childhood height unless small for gestational age
Parental heights - the underlying genetic component, a particularly strong influence
Puberty - early developers are taller for age than late developers
Health (general health and chronic disease)- growth is adversely affected by chronic illness, e.g. Crohn’s disease, chronic renal failure
Specific growth disorders - e.g. growth hormone deficiency, hypothyroidism
Socio - economic status - children from affluent areas, are, on average, taller than children from poor areas
Psycho - social deprivation - can cause profound growth retardation
What are all the growth and development tools?
Height/ Length/ Weight
Growth Charts and plotting
MPH and Target centiles
Growth velocity
Bone age
Pubertal assessment
What are the three phases of growth?
What are the factors that stimulate this growth?
- Infantile phase (0-2) - Nutrition and insulin like growth factors, largely independant of growth hormone
- Childhood phase (2-12) - More dependant on growth hormone and thyroxine
- Pubertal phase (12 - final height) - dependant on the sex steroid that causes the release in growth hormone
Males - Testosterone
Females - Oestrogen
Acceleration is limited by the fusion of epiphysis (caused by oestrogen in both sexes)
What are the stages of growth in girls?
Grow fast at the start of puberty
Peak height velocity is at 12 years (B2-3)
Slows down in later stages of puberty when breast development is mature (B4-B5)
When menarche occurs (13-13.5 years old) girls are close to their final height
What are the stages of height growth in boys?
Grow slowly at start of puberty (G2) – still in childhood growth phase
Accelerate in mid - puberty (coincides with growth of penis, G3)
Peak height velocity at 14 yr (G4)
Further growth after pubertal development is complete (G5)
What are the most important pubertal stages?
Breast budding (Tanner Stage B2) in a girl
Testicular Enlargement (G2 T3-4ml) in a boy
The second stage in the tanner score always correlates to the start of puberty
These are the earliest objective signs of puberty
• and when present puberty will usually progress onwards
What are the causes of early sexual development?
Infantile thelarche - Thelarche means “the beginning of breast development.”
Thelarche variant
True central precocious puberty - precocious puberty is puberty occurring at an unusually early age
Most cases, the process is normal in every aspect except the unusually early age, and simply represents a variation of normal development. In a minority of children, the early development is triggered by a disease such as a tumor or injury of the brain. Even when there is no disease, unusually early puberty can have adverse effects on social behavior and psychological development, can reduce adult height potential, and may shift some lifelong health risks
Precocious pseudopuberty:
Gonadotrophin independent (low/prepubertal levels of LH and FSH)
- Abnormal sex steroid hormone secretion
- Virilasing or feminasing
the development of male physical characteristics (such as muscle bulk, body hair, and deep voice) in a female or precociously in a boy, typically as a result of excess androgen production.
• Clinical picture: secondary sexual characteristics
