Paediatric Endocrinology and Diabetes Flashcards
What instrument is used to measure height?
Stadiometer
As well as standing height, what other kind of height should be measured in children?
Seated height
How is head circumference in children measured?
Tape round forehead and occipital prominence (maximal circumference)
What should be done after measuring a childs height?
Plot onto a graft accurately (centile chart)
As well as centile charts, what other growth charts are there?
Charts for predicting future height, and condition specific growth charts
What is target height and mid parental height (MPH)?
Potential height a child could reach
What is bone age?
Degree of maturation of a child’s bones
What is used to predict a childs adult height?
Childs height and bone age
What is the method called for staging puberty?
Tanner method:
B (breast development)
G (genital development)
PH (pubic hair)
AH (axillary hair)
T (testes volume)
What does B for Tanners method range from?
1 to 5 (breast development)
What does G for Tanners method range from?
1 to 5 (genital development)
What does PH for Tanners method range from?
1 to 5 (pubic hair)
What does AH for Tanners method range from?
1 to 3 (axillary hair)
What does T for Tanners method range from?
2ml to 20ml (testes volume)
What is used to measure testicular maturation?
Prader orchidometer
As well as height, what else is important for assessing a childs growth?
Birth weight and gestation
PMH
Family history/social history/schooling
Systemic enquiry
Dysmorphic features
Systemic examination
Give a summary of assessment tools for measuring a childs growth?
Height/length/weight
Growth charts and plotting
MPH and target centiles
Growth velocity
Bone age
Pubertal assessment
Why is a precise definition of normal growth difficult?
Wide range within healthy population
Different ethnic subgroups
Inequality in basic health and nutrition
Normally relate to individuals or populations (genetic influence)
What are some factors influencing height?
Age
Sex
Race
Nutrition
Parental heights
Puberty
Skeletal maturity (bone age)
General health
Chronic disease
Specific growth disorders
Socio-economic class
Emotional well-being
Shape of normal growth has stages, what are these?
Infantile
Childhood
Pubertal
What hormones are involved in puberty?
LH = Luteinizing Hormone
FSH = Follicle Stimulating Hormone
Testosterone
What is the relationship between growth and other changes in puberty?
What are the most important pubertal stages?
Breast budding (tanner stage B2) in a girl
Testicular enlargement (tannger stage G2, T3-4ml) in a boy
these are earliest objective signs of puberty
Do girls and boys tend to grow at the same rate?
They do until they are about 13
What are some indications for referral for growth disorders?
Extreme short or tall stature (off centiles)
Height below target height
Abnormal height velocity (crossing centiles)
History of chronic disease
Obvious dysmorphic syndrome
Early/late puberty
What are some common causes of short stature?
Familial
Constitutional delay of growth and puberty (CDGP)
Small for gestational age (SGA)
What does SGA stand for?
Small for gestational age
What does CDGP stand for?
Constitutional delay in growth and puberty
What are some pathological causes of short stature?
Undernutrition
Chronic illness (JCA, IBD, Coeliac)
Iatrogenic (steroids)
Psychological and social
Hormonal (GHD, hypothyroidism)
Syndromes (Turner, Prader-Willi, Noonan’s, Achondroplasia)
When are boys considered to have early/late puberty?
Early - <9 years (rare)
Late - >14 years (common)
When are girls considered to have early/late puberty?
Early - <8 years
Late - >13 years (rare)
Is it more common for boys to have early or late puberty?
Late
Is it more common for girls to have early or late puberty?
Early
Who does CDGP usually affect?
Boys
What is seen in CDGP?
Family history in dads or brothers
Bone age delay
Need to exclude organic disease
What are some causes of delayed puberty?
CDGP
Gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
Chronic disease (Crohn’s, asthma)
Impaired HPG axis (septo-optic dysplasia, craniopharyngioma, Kallman’s syndrome)
Peripheral (cryptorchidism, testicular irradication)
What is central precocious puberty?
Condition that causes early sexual development in girls and boys
What are some signs of early sexual development?
What are some signs of central precocious puberty?
Breast development in girls
Testicular enlargement in boys
Growth spurt
Advanced bone age
What is the treatment for central precocious puberty?
GnRH agonist
What is precocious pseudopuberty?
Partial pubertal development that results from autonomous production of testosterone in a prepubertal boy
(low/prepubertal levels of LH and FSH)
Virilising or feminising
What is ambigous genialia?
Infants external genitals dont appear to be clearly either male or female
Wha examination should be done for ambiguous genitalia?
Examination of the gonads/internal organs
What investigation should be done for ambiguous genitalia?
Karyotype
What should be excluded from the differential diagnosis before diagnosing ambigous genitalia?
Congenital adrenal hyperplasia
What is the incidence of congenital hypothyroidism?
1/4000 births
Is there newborn screening for congenital hypothyroidism?
Yes
What is the most common cause of acquired hypothyroidism in children?
Autoimmune (Hashimoto’s) thyroiditis
What are some complications of acquired hypothyroidism in children?
Lack of height gain
Pubertal delay
Poor school performance
Is FH important for acquired hypothyroidism?
Yes, family history of thyroid/autoimmune disorders often seen
What percentage of children (aged between 2 and 15) are overweight or obese?
31%
What assessments should be done for obese children?
Weight
BMI (kg/m2)
Height
Waist circumference
Skin folds
History and examination
Complications
What is the formula for BMI?
Weight (kg) / Height2 (m)
Over what centile of BMI are children overweight?
85th centile
Over what centile of BMI are children obese?
Over 97.5
What parts of the history are important for children who are short and obese?
Diet
Physical activity
Family history
Symptoms suggestive of what things should be looked for in the history for short obese children?
Syndrome
Hypothalamic-pituitary pathology
Endocrinopathy
Diabetes
What are examples of some possible complications of children being short and obese?
What are some causes of children being obese and short?
Simple obesity
Drugs (insulin, steroids, antithyroid drugs, sodium valproate)
Syndromes (Prader Willi syndrome, Laurence-Moon-Beidl syndrome, pseudohypoparathyroidism type 1, down’s syndrome)
Endocrine disorders (hypothyroidism, growth hormone deficiency, glucocorticoid excess, hypothalamic lesion, androgen excess, insulinoma, insulin resistance syndromes)
Hypothalamic damage
What kinds of things are used for the treatment of obest and short children?
Diet
Exercise
Psychological input
Drugs
What’s the main complication of endocrine disorders in short and obese children?
Growth failure
What’s the main complication of syndromes in short and obese children?
Learning difficulties
What’s the main complication of hypothalamic causes in short and obese children?
Loss of appetite control
Why is early important for diabetic children important?
Otherwise children can present critically unwell, such as with DKA, and perhaps die
What does DKA stand for?
Diabetic keoacidosis
What symptoms should you think about for diagnosis diabetes early?
Thirsty (polydipsia)
Thinner
Tired (fatigue)
Using toilet more (polyuria)
Return to bedwetting at night or day wetting (nocturnal enuresis)
What test should be done to diagnose diabetes early?
Finger prick capillary glucose test, result > 11mmol/L
What result for the finger prick test indicates diabetes?
>11mmol/L
After identifying the symptoms and performing a finger prick test, what should be done to diagnose diabetes early?
Refer to local specialist for same day review
What are some DKA symptoms?
Nausea and vomiting
Abdominal pain
Sweet smelling breath
Drowsiness
Rapid, deep sighing respiration
Coma
What should not be done, that perhaps would be done for a suspected diabetes diagnosis, when you suspect a child has DKA?
Request a returned urine specimen
Arrange a fasting blood glucose test
Arrange an oral glucose tolerance test
Wait for lab results (urine or blood)
