Paediatric Growth and Endocrine

Question 1

What factors influence height?

Answer 1

Age
Sex
Nutrition
Parental heights
Race
Puberty
Skeletal maturity
General health
Chronic disease
Specific growth disorders
Socio-economic status
Emotional well-being

Question 2

What tools can be useful in assessing paediatric growth?

Answer 2

Height/length/weight
Growth charts
Mid-parental height and target centiles
Growth velocity
Bone age
Pubertal assessment

Question 3

What are the indications for referral for investigation of growth disorder?

Answer 3

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

Question 4

What are the non-pathological causes of short stature?

Answer 4

Familial
Constitutional
Small for gestational age/intra-uterine growth restriction

Question 5

What are the pathological causes of short stature?

Answer 5

Undernutrition
Chronic illness (ie coeliac)
Iatrogenic (steroids)
Psychological and social
Hormonal
Syndromes (turners)

Question 6

How is puberty staged?

Answer 6

Using the Tanner method

Question 7

What are the component parts of the Tanner method?

Answer 7

Breast development (B)- 1-5
Genital development (G)- 1-5
Pubic hair (PH)- 1-5
Axillary hair (AH)- 1-3
Testes (T)- 2ml-20ml

Question 8

When is puberty considered early?

Answer 8

< 9 years old in boys (rare)

<8 in girls

Question 9

When is puberty considered delayed?

Answer 9

> 14 in boys (common)

>13 in girls (rare)

Question 10

What is constitutional delay of growth and puberty?

Answer 10

Constitutional delay of growth and puberty (CDGP) mainly affects boys and there is usually a family history in males but this is often difficult to obtain. There is usually an associated bone growth delay and it is important to rule out organic causes.

Question 11

What are some causes of delayed puberty?

Answer 11

Gonadal dysgenesis (Turner 45XX etc)
Chronic disease- Crohn’s, asthma
Impaired HPG (hypothalamic-pituitary-gonadal) axis 
Peripheral causes (cryptorchidism, testicular irradiation)

Question 12

What aspect of puberty does congenital adrenal hyperplasia mainly affect?

Answer 12

Secondary sexual characteristic development

Question 13

What are the features of central precocious puberty?

Answer 13

Central precocious puberty is associated with early pubertal development causing early breast development in girls and testicular enlargement in boys. It can also cause an early growth spurt and advanced bone age. It is important to rule out a pituitary lesion, which can be done with MRI

Question 14

What are the features of precocious pseudopuberty?

Answer 14

Precocious pseudopuberty is caused by abnormal sex steroid secretion and is gonadotrophin independent, meaning that it should have low or pubertal levels of FSH and LH. The clinical picture involves secondary sexual characteristics and it is important to exclude congenital adrenal hyperplasia.

Question 15

What is the approach to management of ambiguous genitalia?

Answer 15

Do not guess sex of baby
Multidisciplinary approach
Examination to assess gonads and internal organs
Karyotype testing
Exclude congenital adrenal hyperplasia as this is associated with a risk of adrenal crisis in the first two weeks of life

Question 16

What are the causes of congenital hypothyroidism?

Answer 16

Athyreosis (absence of thyroid)
Hypoplastic or ectopic thyroid
Dyshormonogenic

Question 17

How is congenital hypothyroidism diagnosed and treated?

Answer 17

Picked up on newborn screening and treatment should be started in the first two weeks.

Question 18

What is the most common cause of acquired hypothyroidism?

Answer 18

Hashimoto’s (autoimmune) thyroiditis

Question 19

What childhood issues are associated with acquired hypothyroidism?

Answer 19

Lack of height gain
Pubertal delay or precocity
Poor school performance

Question 20

What is the incidence of obesity in children?

Answer 20

~1/3 children aged 2-15 are obese or overweight.

Question 21

How can obesity be assessed clinically?

Answer 21

Weight
BMI
Height
Waist circumference
Skin folds
History and examination
Assessment of complications

Question 22

What are the causes of obesity in children?

Answer 22

Simple obesity (most common, increased intake + reduced activity)
Drugs
Syndromes
Endocrine disorders
Hypothalamic damage

Question 23

How is obesity managed in children?

Answer 23

Diet
Exercise
Psychological input

Question 24

What is the approach to a prompt diabetes diagnosis in children?

Answer 24

• THINK- symptoms, 4 T’s:
- Thinner
- Thirsty
- Tired
- Using Toilet more
• TEST- immediately, finger prick glucose test. +ve if >11mmol/L
• TELEPHONE- contact referral team immediately

Question 25

What are the symptoms of diabetes in children under 5?

Answer 25

A return to bedwetting or day-wetting in a previously dry child is a red flag for diabetes. 
Other symptoms of diabetes that should be thought of in children under five are:
•Heavier nappies
•Blurred vision
•Candidiasis
•Constipation
•Recurring skin infections
•Irritability + behaviour change

Question 26

What are the symptoms of diabetic ketoacidosis?

Answer 26

Nausea and vomiting
Abdominal pain
Sweet-smelling ketotic breath
Drowsiness
Rapid, deep respiration
Coma