paediatric growth and endocrine Flashcards
https://www.abdn.ac.uk/medical/learning/pluginfile.php/11497/mod_page/content/3/Year%203%20Paediatric%20endocrinology%20and%20diabetes%20slides%20-%20A%20Mayo.pdf
growth assessment tools
height/length, weight growth charts + plotting MPH and target centiles growth velocity bone age pubertal assessment
growth disorders: indications for referral
- extreme short/tall stature (off centiles)
- height below target height
- abnormal height velocity (crossing centiles)
- hx chronic disease
- obvious dysmorphic syndrome
- early/late pubery
common causes of short stature
familial
constitutional
SGA/IUGR
growth investigaions
FBC + ferritin U&E, LFTs, Ca, CRP coeliac serology and IgA IGF-1, TFT, prolactin, cortisol karyotype/microarray
staging of puberty: tanner method
breast development
genital development
pubic hair
axillary hair
early and delayed puberty: boys
early <9yrs
delayed >14
early and delayed puberty: girls
early <8yrs
delayed >13
constitutional delay of growth and puberty
boys mainly
FH in dad or brothers
bone age delay
need to exclude organic disease
pathological causes of short stature
undernutrition chronic illness - IBD, coeliac iatrogenic - steroids psychological, social hormonal (GHD, hypothyroid, glucocorticoid excess) syndromes - Turner, P-W, Noonan, PHPT skeletal dysplasias
Turner syndrome: gene and who
45X0
girls
turner syndrome features
poor growth, short stature 1ry amenorrhea (ovarian dysgenesis) delayed/absent pubertal development webbed neck skeletal abnormalities congenital heart defects: aortic coarctation, bicuspid aortic valve
prader-willi syndrome genes
deletion of 15q11-q13 chromosome region
noonan’s syndrome features
autosomal dominant short stature abnormal facial features congenital heart defects: pulm valve stenosis chest deformities
causes of delayed puberty
chronic disease - Crohn’s, asthma
constitutional
primary gonadal disorders
impaired HPG axis
central precocious puberty
true pubertal development - breast development/testicular enlargement
growth spurt
advancing bone age
assessment of childhood obesity
weight BMI height waist circumference skin folds hx and exam complications
obese + short =
abnormal
complications of childhood obesity
metabolic syndrome fatty liver disease gallstones thromboembolic disease pancreatitis obstructive sleep apnoea GORD psychological left ventric hypertrophy RS heart failure
causes of childhood obesity
simple obesity drugs syndromes endocrine disorders hypothalamic damage
managing childhood obesity
diet
exercise
psychological input
drugs»
small and obese child: endocrine cause
growth failure
small and obese child: syndromes
learning difficulties
small and obese child: hypothalamic cause
loss of appetite control
small and obese child: genetic causes
starts <5yrs
diabetic symptoms chldhood
thirsty
tired
thinner
using toiler more
return to bedwetting - reg flag for diabetes
other diabetes features in kids <5yrs
heavier nappies than usual blurred vision candidiasis - oral, vulval constipation recurring skin infection irritability
first test for childhood diaberes
finger prick capillary blood test
> 11 mmol/l - diabetes
<11mmol/l - other cause
making early diagnosis of childhood diabetes
T symptoms (thirsty, thinner, tired, toilet more)
test - finger prick glct test
telephone - same day specialist review
tanner I
prebupertal
tanner II
minimal pubic hair
breast budding
tanner III
voice changes, pubic hair over penis
PH, AH, breast enlargement
tanner IV
adult pubic hair
areolar enlargement
tanner V
as adult
pader willi syndrome features
short stature
infantile hypotonia/poor feeding
childhood hyperphagia, obesity
developmental delay
early sexual development: breast development
hypothalamic activation
e.g. central precocious puberty
early sexual development: secondary sexual characteristics
sex steroid hormone secretion
e.g. precocious pseudopuberty
