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Year 3 > Paediatric Growth and Endocrine > Flashcards

Paediatric Growth and Endocrine Flashcards

1
Q

discuss normal child growth

A

A precise definition of what is normal growth is difficult. There is a wide range within a health population and further range in ethnic subgroups. There is inequality in basic health and nutrition. Normality may relate to individuals or populations (genetic influence).

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2
Q

list the factors influencing height

A
  • Age
  • Sex
  • Race
  • Nutrition
  • Parental heights
  • Puberty
  • Skeletal maturity (bone age)
  • General health
  • Chronic disease
  • Specific growth disorders
  • Socio-economic status
  • Emotional well-being
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3
Q

child measurement techniques

A 
• Length
• Height
• Sitting height
• Head circumference
o Routine in children < 2 years
o Tape round forehead and occipital prominence (maximal circumference)
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4
Q

describe bone age TW20

A

standardised left hand
• Radiographs must be of high quality
• Evaluation by skilled practitioner
• Pathological conditions can distort bones
• Severe osteopenia confuses interpretation

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5
Q

growth disorders: indicators for referral

A
  • 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
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6
Q

common causes of short stature

A

familial
constitutional
IUGR

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7
Q

pathological causes of short stature

A
  • Undernutrition
  • Chronic illness (JCA, IBD, coeliac)
  • Iatrogenic (steroids)
  • Psychological and social
  • Hormonal (GHD, hypothyroidism)
  • Syndromes (Turner, P-W)
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8
Q

investigation of short stature: FBC and ferritin

A

general health
coeliac
Crohn’s
JIA

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9
Q

investigation of short stature: U+E, LFT, Ca, CRP

A

general health
renal and liver disease
disorders of Ca metabolism

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10
Q

investigation of short stature: coeliac serology and IgA

A

coeliac

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11
Q

investigation of short stature: IGF-1, TFT, Prolactin, cortisol (gonadotrophins and sex hormones)

A

hormonal disordres

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12
Q

investigation of short stature: karyotype

A

Turner’s syndrome

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13
Q

if IGF-1 is low what would you proceed to do?

A 
• Proceeded to GH stimulation test:
o Arginine test
o Insu
• Isolated growth hormone deficiency
• MRI pituitary:
o Ectopic posterior pituitary gland
o Small anterior pituitary
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14
Q

give an overview od the Tanner Staging of puberty

A 
Breast development (B)
o 1-5
• Genital development (G)
o 1-5
• Pubic hair (PH)
Figure 2 Investigations of Small Stature
o 1-5
• Axillary hair (AH)
o 1-3
• Testicular volume
o 2ml to 20ml
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15
Q

relationship between growth and other changes in puberty: boys

A

see notes

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16
Q

relationship between growth and other changes in puberty: girls

A

see notes

17
Q

early and delayed puberty: boys

A

< 9

> 14

18
Q

early and delayed puberty: girl

A

< 8

> 13

19
Q

constitutional delay of growth and puberty

A

This affects boys mainly. There is commonly a family history in dad or brothers, however, this may be difficult to obtain. Bone age delay. Need to exclude organic disease.

20
Q

causes of delayed puberty

A

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 irradiation)

21
Q

early sexual development

A

• Breast development (hypothalamic activation)
o Infantile thelarche
o Thelarche variant (premature thelarche)
o Central precocious puberty)
• Secondary sexual characteristics (sex steroid hormone secretion)
o Exaggerated adrenarche
o Precocious pseudopuberty (i.e. congenital adrenal hyperplasia)
• PV bleeding
o Premature menarche

22
Q

central precocious puberty

A 
• Pubertal development
o Breast development in girls
o Testicular enlargement in boys
• Growth spurt
• Advanced bone age
• Need to exclude pituitary lesion – MRI
23
Q

precocious pseudopuberty

A
  • Abnormal sex steroid hormone secretion
  • Gonadotrophin independent (low/prepubertal levels of LH and FSH)
  • Clinical picture: secondary sexual characteristics
  • Need to exclude congenital adrenal hyperplasia
24
Q

ambiguous genitalia: management approach

A
  • Do not guess the sex of the baby!
  • MDT – paed endo, surgical, neonatologist, geneticist, psychologist
  • Exam: gonads?/internal organs
  • Karyotype
  • Exclude congenital adrenal hyperplasia – risk of adrenal crisis is 1st 2 weeks of life
25
Q

congenital hypothyroidism: causes

A

athyreosis
hypoplastic
ectopic
dyshormonogenic

26
Q

congenital hypothyroidism: when to start treatment?

A

within first 2 weeks

27
Q

congenital hypothyroidism: how is it identified?

A

newborn blood screening

28
Q

acquired hypothyroidisim

A

• Most common cause: autoimmune (Hashimoto’s) thyroiditis
• Family history of thyroid/autoimmune disorders
• Childhood issues:
o Lack of height gain
o Pubertal delay (or precocity)
o Poor school performance (but work steadily)

29
Q

assessment of obese children

A
  • Weight
  • BMI
  • Height
  • Waist circumference
  • Skin folds
  • History and examination
  • Complications
30
Q

complications of childhood obesity

A
  • Metabolic syndrome
  • Fatty liver disease (non-alcoholic steatohepatitis
  • Gallstones
  • Reproductive dysfunction (e.g. PCOS)
  • Nutritional deficiencies
  • Thromboembolic disease
  • Pancreatitis
  • Central hypoventilation
  • Obstructive sleep apnoea
  • Gastroesophageal reflux disease
  • Orthopaedic problems (slipped capital femoral epiphysis, tibia vara)
  • Stress incontinence
  • Injuries
  • Psychological
  • Left ventricular hypertrophy
  • Atherosclerotic cardiovascular disease
  • Right sided heart failure
31
Q

causes of childhood obesity

A
  • Simple obesity
  • Drugs
  • Syndromes
  • Endocrine disorders
  • Hypothalamic damage
32
Q

treatment of childhood obesity

A 
• Diet
• Exercise
• Psychological input
• Drugs??
Simple obesity is the most common cause. Investigations are rarely necessary
33
Q

making an early diagnosis of diabetes

A
  1. THINK symptoms
    a. Thirsty
    b. Thinner
    c. Tired
    d. Using the toilet more
  2. TEST immediately
    a. Finger prick capillary glucose test
    b. If result > 11 mmol/l
  3. TELEPHONE urgently
    a. Contact your local specialist team for a same day review
34
Q

when to consider diabetes in children

A 
A return to bedwetting or day wetting in a previously dry child is a red flag symptom for diabetes. In
children under five also think:
• Heavier than usual nappies
• Blurred vision
• Candidiasis (oral, vulval)
• Constipation
• Recurring skin infections
• Irritability, behaviour change
35
Q

DKA symptoms

A
  • N+V
  • Abdo pain
  • Sweet smelling “ketotic” breath
  • Drowsiness
  • Rapid, deep “sighing” respiration
  • Coma
36
Q

testing for diabetes in children

A

• Finger prick capillary blood glucose test
o Result > 11 – diabetes
o Result < 11 – other cause

Year 3 (164 decks)

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