Paediatric Growth and Endocrine

Question 1

what is ‘normal’ growth?

Answer 1

The progression of changes in height, weight and head circumference that are compatible with established standards for a given population.
- wide range withing healthy pop
- different ethnic subgroups
- inequality in basic health and nutrition
- normality may relate to individuals or populations (genetic influence)

Question 2

list factors influencing height

Answer 2

• age
• sex
• race
• nutrition
• parental heights > particularly strong influence
• puberty
• poor health
• skeletal maturity (bone age)
• general health
• chronic disease
• specific growth disorders
• socio-economic status
• emotional well-being

Question 3

Describe the infantile growth phase.
What factors does it depend on?

Answer 3

• rapid period of growth from 0-2 years
• depends on factors such as nutrition and insulin-like growth factors (IGF1 & IGF2)
• largely independent of growth hormone

Question 4

Describe the childhood growth phase. What factors does it depend on?

Answer 4

• long phase of growth from 2-12 years (onset of pubertal growth)
• slower, slightly decelerating curve
• more dependent on growth hormone and thyroxine

Question 5

Describe the pubertal growth phase. What factors does it depend on?

Answer 5

• from around age 12 to final height
• dependent on the sex steroid that causes an increase in growth hormone secretion: testosterone in boys, oestrogen in girls.
• resulting growth acceleration is limited by fusion of the epiphyses (due to oestrogen in both sexes)
• variable growth phase in terms of: age of onset, duration and intensity

Question 6

what are some assessment tools for monitoring a childs growth?

Answer 6

• height/length/weight
• growth charts and plotting
• MPH and target centiles
• growth velocity
• bone age
• pubertal assessment

Question 7

Growth disorders: indications for referral

Answer 7

• 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

Question 8

what are some pathological causes for short stature?

Answer 8

• undernutrition
• chronic illness (JCA, IBD, Coeliac)
• iatrogenic (steroids)
• psychological and social
• hormonal (GHD, Hypothyroidism)
• syndromes (Turner, P-w)

Question 9

what are some investigations to perform if looking for a pathological cause of abnormally short stature?

Answer 9

• FBC and ferritin > general health, coeliac, Chrone’s, JCA
• U&E, LFT, Ca, CRP > general health, renal and liver disease, disorders of Ca metabolism
• coeliac serology and IgA
• IGF-1, TFT, Prolactin, cortisol, gonadotrophins and sex hormones .> hormonal disorders
• karyotype > Turner’s syndrome

Question 10

Describe the Tanner method of puberty staging.

Answer 10

• B 1-5 (breast development)
• G 1-5 (genital development)
• PH 1-5 (pubic hair)
• AH 1-3 (axillary hair)
• T (2ml to 20ml)

Question 11

Men end up taller than women because of three factors:

Answer 11

• pubertal growth spurt starts 2 years later than in girls
• pubertal growth spurt is more intense in boys
• boys are slightly bigger than girls during childhood

Question 12

what is considered early and delayed puberty in boys?

Answer 12

early < 9 years (rare)
delayed > 14 (common, esp. CDGP)

Question 13

What is considered early and delayed puberty in girls?

Answer 13

early < 8 years
delayed > 13 (rare)

Question 14

list some pathological causes of delayed puberty

Answer 14

• gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
• chronic disease (Crohn’s, asthma)
• impaired HPG axis
• peripheral (cryptoorchidism, testicular irradation)

Question 15

diabetic ketoacidosis symptoms

Answer 15

• nausea and vomiting
• abdominal pain
• sweet smelling ‘ketotic’ breath
• drowsiness
• rapid, deep ‘sighing’ respiration
• coma