Paediatric Growth and Endocrine

Question 1

Bone age assesses how well the bone is maturing. How is this done?

Answer 1

X-ray

->TW 20 to look at all 20 bones and assess maturity

Question 2

If a parent is worried about the height of their child, what initially should be done?

Answer 2

Taking good measurement, of the child and the parents, and compare them to the growth deciles.

Question 3

What are some of the indications for referral of a child if you were concerned about a growth disorder?

Answer 3

Extreme short or tall stature (off centiles)
Abnormal height velocity
History of chronic disease
Obvious dysmorphic syndrome
Early/late puberty

Question 4

What can be given to males to bring on the pubertal growth spurt if they are a late developer?

Answer 4

Short course of testosterone

->optional, does not need to be done. Boys tend to be more worried about shorter stature than girls.

Question 5

Why can’t you measure growth hormone as a one off measurement?

Answer 5

Released in a pulsatile manner

Question 6

Which hormone is a more stable hormone and good to measure to assess height?

Answer 6

IGF-1

->insulin-like growth factor 1

Question 7

Which chromosomal syndrome can cause short stature in girls?

Answer 7

Turner’s syndrome

Question 8

Which staging method can be used to assess where in puberty a child is?

Answer 8

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

Question 9

Which hormones are produced in puberty?

Answer 9

GnRH by hypothalamus
LH and FSH by pituitary gland
Testosterone/oestrogen by the gonads

Question 10

Girls usually go through puberty a lot earlier than boys.
At what age?

Answer 10

Around 10

Question 11

What are some of the first signs of puberty in a female?

Answer 11

Breast budding
Growth spurt

->breast budding first sign. Menarche usually later pubertal sign

Question 12

What age do boys tend to start puberty?

Answer 12

11-12

Question 13

What are some of the first signs of puberty in a male?

Answer 13

Penile growth

->growth spurts are later, usually more than halfway through puberty
Facial hair and shaving occurs at the end of puberty.

Question 14

What is considered early puberty in boys?

Answer 14

<9

->rare

Question 15

What is considered delayed puberty in boys?

Answer 15

> 14

->common especially CDGP

Question 16

What is considered early puberty in girls?

Answer 16

<8

Question 17

What is considered delayed puberty in girls?

Answer 17

> 13

->rare

Question 18

List some of the main pathological causes of short stature in children.

Answer 18

Undernutrition
Chronic illness- JCA, IBD, coeliac
Hormonal- GHD, hypothyroidism, glucocorticoid excess
Turner syndrome
Noonan syndrome
Skeletal dysplasia’s
Steroids

Question 19

Which karyotype is seen in Turner’s syndrome?

Answer 19

45X0

Question 20

Features of Turner’s syndrome?

Answer 20

Short stature
Ovarian dysgenesis
Webbed neck
Broad chest and widely spaced nipples

Question 21

What are some associated disorders of Turner’s syndrome?

Answer 21

Cardiac, renal, thyroid, ENT problems

Educational difficulties

Question 22

What is given as treatment for girls with Turner’s syndrome?

Answer 22

Growth hormone

Question 23

Features of Prader-Willi syndrome?

Answer 23

Infantile hypotonia (floppy)/feeding problems
Hyperphagia -> childhood obesity
Short stature
Developmental delay
Hypogonadism

Question 24

Which chromosome has been altered in Prader-Willi syndrome?

Answer 24

Deletion of 15q11-q13 chromosomal region

Question 25

Features of Noonan syndrome?

Answer 25

Typical facial features- probs worth a google Short stature Congenital heat disease e.g. pulmonary valve stenosis

Question 26

Achondroplasia?

Answer 26

Dwarfism- shorter limbs, normal torso A type of skeletal dysplasia

Question 27

Does GH work on those with achodroplasia/dwarfism?

Answer 27

No

Question 28

Very rarely seen but what affect does abuse and poor social circumstances have on growth?

Answer 28

Can stop growing

Question 29

Give two examples of chronic diseases that can cause delayed puberty.

Answer 29

Crohn's Asthma

Question 30

Name some primary gonadal disorders that can cause delayed puberty.

Answer 30

Turner's syndrome Kilnefelter's syndrome ->gonadal dysgenesis seen in these

Question 31

What are some things that can cause impaired HPG (hypothalamic-pituitary-gonadal) axis? Note that an impaired HPG axis can cause delayed puberty.

Answer 31

Septo-optic dysplasia Craniopharyngioma Kallman's syndrome

Question 32

What is central precocious puberty?

Answer 32

When a child starts puberty before the appropriate age Breast development/testicular enlargement. ->requires investigation to ensure no serious pathological cause that requires treatment

Question 33

If a child presented with central precocious puberty, which investigation would you need to do and why?

Answer 33

MRI to exclude pituitary lesion

Question 34

Just something to remember but idk how to word it into a question.

Answer 34

Obese + short = abnormal

Question 35

Four symptoms of diabetes in children?

Answer 35

Four T's Tired Thirst Thinner Toilet more often

Question 36

What are some of the symptoms of diabetic ketoacidosis in children?

Answer 36

Nausea and vomiting Abdominal pain Sweet smelling breath Drowsiness Rapid, deep, 'sighing' respiration Coma

Question 37

If you suspect a child has diabetes, which test should be done immediatly?

Answer 37

Finger prick capillary blood glucose test

Question 38

In a finger prick capillary blood test, what result would be consistent with diabetes?

Answer 38

>11mol/l= diabetes <11mol/l = other cause