Paediatric Growth and Endocrine Flashcards
Bone age assesses how well the bone is maturing. How is this done?
X-ray
->TW 20 to look at all 20 bones and assess maturity
If a parent is worried about the height of their child, what initially should be done?
Taking good measurement, of the child and the parents, and compare them to the growth deciles.
What are some of the indications for referral of a child if you were concerned about a growth disorder?
Extreme short or tall stature (off centiles)
Abnormal height velocity
History of chronic disease
Obvious dysmorphic syndrome
Early/late puberty
What can be given to males to bring on the pubertal growth spurt if they are a late developer?
Short course of testosterone
->optional, does not need to be done. Boys tend to be more worried about shorter stature than girls.
Why can’t you measure growth hormone as a one off measurement?
Released in a pulsatile manner
Which hormone is a more stable hormone and good to measure to assess height?
IGF-1
->insulin-like growth factor 1
Which chromosomal syndrome can cause short stature in girls?
Turner’s syndrome
Which staging method can be used to assess where in puberty a child is?
Tanner staging
->expertise required and chaperone. Looks at breast/genital development, pubic hair, axillary hair
Stage one is before puberty, stage two is at very beginning of puberty
Which hormones are produced in puberty?
GnRH by hypothalamus
LH and FSH by pituitary gland
Testosterone/oestrogen by the gonads
Girls usually go through puberty a lot earlier than boys.
At what age?
Around 10
What are some of the first signs of puberty in a female?
Breast budding
Growth spurt
->breast budding first sign. Menarche usually later pubertal sign
What age do boys tend to start puberty?
11-12
What are some of the first signs of puberty in a male?
Penile growth
->growth spurts are later, usually more than halfway through puberty
Facial hair and shaving occurs at the end of puberty.
What is considered early puberty in boys?
<9
->rare
What is considered delayed puberty in boys?
> 14
->common especially CDGP
What is considered early puberty in girls?
<8
What is considered delayed puberty in girls?
> 13
->rare
List some of the main pathological causes of short stature in children.
Undernutrition
Chronic illness- JCA, IBD, coeliac
Hormonal- GHD, hypothyroidism, glucocorticoid excess
Turner syndrome
Noonan syndrome
Skeletal dysplasia’s
Steroids
Which karyotype is seen in Turner’s syndrome?
45X0
Features of Turner’s syndrome?
Short stature
Ovarian dysgenesis
Webbed neck
Broad chest and widely spaced nipples
What are some associated disorders of Turner’s syndrome?
Cardiac, renal, thyroid, ENT problems
Educational difficulties
What is given as treatment for girls with Turner’s syndrome?
Growth hormone
Features of Prader-Willi syndrome?
Infantile hypotonia (floppy)/feeding problems
Hyperphagia -> childhood obesity
Short stature
Developmental delay
Hypogonadism
Which chromosome has been altered in Prader-Willi syndrome?
Deletion of 15q11-q13 chromosomal region
Features of Noonan syndrome?
Typical facial features- probs worth a google
Short stature
Congenital heat disease e.g. pulmonary valve stenosis
Achondroplasia?
Dwarfism- shorter limbs, normal torso
A type of skeletal dysplasia
Does GH work on those with achodroplasia/dwarfism?
No
Very rarely seen but what affect does abuse and poor social circumstances have on growth?
Can stop growing
Give two examples of chronic diseases that can cause delayed puberty.
Crohn’s
Asthma
Name some primary gonadal disorders that can cause delayed puberty.
Turner’s syndrome
Kilnefelter’s syndrome
->gonadal dysgenesis seen in these
What are some things that can cause impaired HPG (hypothalamic-pituitary-gonadal) axis?
Note that an impaired HPG axis can cause delayed puberty.
Septo-optic dysplasia
Craniopharyngioma
Kallman’s syndrome
What is central precocious puberty?
When a child starts puberty before the appropriate age
Breast development/testicular enlargement.
->requires investigation to ensure no serious pathological cause that requires treatment
If a child presented with central precocious puberty, which investigation would you need to do and why?
MRI to exclude pituitary lesion
Just something to remember but idk how to word it into a question.
Obese + short = abnormal
Four symptoms of diabetes in children?
Four T’s
Tired
Thirst
Thinner
Toilet more often
What are some of the symptoms of diabetic ketoacidosis in children?
Nausea and vomiting
Abdominal pain
Sweet smelling breath
Drowsiness
Rapid, deep, ‘sighing’ respiration
Coma
If you suspect a child has diabetes, which test should be done immediatly?
Finger prick capillary blood glucose test
In a finger prick capillary blood test, what result would be consistent with diabetes?
> 11mol/l= diabetes
<11mol/l = other cause
