Paediatric Growth And Endocrine Flashcards
What are the patterns of normal growth from foetal life through puberty with its normal and abnormal variations?
Peak in infancy, slower throughout childhood and then a peak in puberty before stopping at final height pre-20 years old.
How are growth measurements taken?
Infancy = length Head circumference (<2yo) Once can walk = height, standing & sitting Bone age
What key features are identified in a history and examination when assessing a growth disorder?
Birth weight and gestation Past medical Family/social/schooling Systematic enquiry Dystrophic features
Systematic examination
- height/length/weight
- growth charts, mid parental height and target centilds
- growth velocity
- bone age
- pubertal assessment
What are the variations in the normal pattern of growth and pubertal development?
Early puberty: <9yo in boys, <8yo in girls
Delayed puberty: >14yo in boys, >13yo in girls
How is pubertal development in childhood assessed and interpreted?
Puberty is staged using the Tanner Method: B 1-5 (breast development) G 1-5 (genital development) PH 1-5 (pubic hair) AH 1-3 (axillary hair) T 2-20ml SO eg statement
Testicular maturation: prader orchidometer
Key: breast budding is B2, testicular enlargement is G2-T3-4ml
What are the common causes and principles of investigation of precocious and delayed puberty?
Delayed: constitutional, gonadal dysgenesis eg turner, klinefelter, chronic disease, impaired HPG axis, peripheral eg cryptorchidism, testicular irradiation
Precocious: central precocious puberty (premature secretion of gonadotropin), precocious pseudo puberty (abnormal sex steroid hormone secretion independent of gonadotropin - affects secondary sex characteristics)
Investigations: bone age, exclude organic disease eg MRI
What is the approach to short stature including investigation and differential diagnosis?
Differential diagnosis:
- Familial
- Constitutional delay of growth and puberty
- SGA (small for gestational age)/IUGR (intrauterine growth retardation)
- Pathological eg under nutrition, chronic illness (juvenile chronic arthritis, inflammatory bowel disease, coeliac), iatrogenic, psychological and social, hormonal (growth hormone deficiency, hypothyroid), syndromes (turners, prader Willis)
Investigations:
- FBC, ferritin
- U&E, LFTs, Ca, CRP
- Coeliac serology and IgA
- IGF-1, TFT, prolactin, cortisol
- Karyotype
What are the main patterns of growth disorders? Eg, when do you refer
Extremely short or tall eg off centrioles
Height below target height
Abnormal height velocity eg crossing centiles
History of chronic disease
Obvious dystrophic syndrome
Early/late puberty
What are the more common endocrinopathies?
including congenital hypothyroidism, congenital adrenal hyperplasia and growth hormone deficiency
Congenital hypothyroidism: screened for, treat within 2 weeks
Acquired hypothyroidism: usually autoimmune, with family history. Child has lack of height gain, problems with puberty and poor school performance even though working
Obesity
What genetic syndromes affect growth?
Turners syndrome, prader-Willis, klinefelter, kallmans syndrome
How is childhood obesity assessed and managed?
Assessment
History & exam:
diet, physical activity, family history + symptoms suggestive of syndromes, hypothalamic-pituitary pathology, endocrinopathology, diabetes
Investigations (rarely necessary):
weight, BMI, height (waist circumference, skin folds, any complications)
Management:
diet, exercise, psychological input, drugs?
How are new patients with suspected diabetes managed?
Suspicion of diabetes when presenting with symptoms (thirsty, thinner, tired, using toilet more) then test (finger prick) and if result >11mmol/L: telephone local team for same day review.
Be aware of DKA symptoms: N&V, abdo pain, sweet smelling ketotic breath, drowsiness, rapid, deep “sighing” respiration, coma
