Paediatric Growth and Endocrine Flashcards
What is ‘normal’ growth?
•Precise definition difficult:
- Wide range within healthy population
- Different ethnic subgroups
- Inequality in basic health and nutrition
- Normality may relate to individuals or populations (genetic influence)
how should height be measured?
essential to have good measurements, good technique and equipment
when should you take measurements of a child?
Value of serial measurements: ‘make every contact count’
important to have many measurements, should be measured at every contact
how can you predict a child height?
Target Height and Mid Parental Height (MPH)
short parents make short children
what is bone age?
left has delayed bone age and right has very advanced bone age
A bone age study helps doctors estimate the maturity of a child’s skeletalsystem. It’s usually done by taking a single X-ray of the left wrist, hand, and fingers
assessment of bone maturation, x-ray of the left hand, analyse maturity of 20 bones
if someone is short with a delayed bone age this may mean they still have the potential to grow as they have a young skeleton
Basics are so important!! - what may unaccurate measurements lead to?
may put child through unnecessary investigations
Summary: Assessment Tools
- Height/ length/ weight
- Growth Charts and plotting
- MPH and Target centiles
- Growth velocity
- Bone age
- Pubertal assessment
want to get more information
History and further examination - what would you do?
- Birth weight and gestation
- PMH
- Family history/social history/schooling
- Systematic enquiry
- Dysmorphic features
- Systemic examination including pubertal assessment
Growth disorders: what are indications for referral?
- 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
what are some common causes for short stature?
- Familial - short child from a short family
- Constitutional - Constitutional delay of growth and puberty - variant of normal, will be late developers, will be fine
- SGA/IUGR
Variations of normal
what investigations can be done and what do they look for?
what is used to assess where children are in puberty and how is it done?
Staging of puberty: Tanner method
what are the stages?
stage 2 is beginning of puberty, stage 1 means haven’t started
what hormones are involved in puberty?
these hormones cause breast development in girls and testicular enlargement in boys, also get pubic hair and axillary hair but these are mediated by adrenal hormones and these are produced around when children go into puberty and they produce secondary sexual characteristics in boys and girls (pubic and axillary hair)
Relationship between growth and other changes in puberty: how ar ebyos and girls different?
tempo of puberty different between boys and girls, menarche is a late development, boys start puberty on average a year later and have a later growth spurt that is more marked
what is classed as early and delayed puberty in boys and girls?
•Boys
- early < 9 years (rare)
- delayed >14 (common, especially CDGP)
•Girl
- early <8 years
- delayed >13 (rare)
Constitutional Delay of Growth and Puberty (CDGP) - who does it occur in and why?
- Boys mainly
- Family history in dad or brothers (difficult to obtain!)
- Bone age delay
- Need to exclude organic disease
Puberty essentials:
•Pubertal staging:
- Breast budding (Tanner Stage B 2) in a girl
- Testicular enlargement (Tanner Stage G2 -T 4 ml) in boy
- Pubertal tempo
- Normal pubertal age
Short stature: What are Pathological causes?
- Undernutrition
- Chronic illness (JCA, IBD, Coeliac)
- Iatrogenic (steroids)
- Psychological and social
- Hormonal (GHD, hypothyroidism, glucocorticoid excess)
- Syndromes (Turner, P-W, Noonan, PHPT)
- Skeletal dysplasias
picture - hypothyroidism, fallen off centiles, mainly loss of height, short and obese child and you should always be worried about this
what are the features of Turner Syndrome (45X0)?
•Short Stature
•Ovarian dysgenesis (ovaries not fully formed)
- Associated disorders: cardiac, renal, thyroid, ENT problems
- Psychosocial/educational difficulties
- Physical stigmata (wide or web-like neck, wide spaced nipples, shielded chest, wide carrying angle, small nails, short limbs, low set ears)
what happens if you give someone with Turners syndrome GH?
growth chart of turners syndrome, starts to fall off the centiles, treat girls with turners with GH, start to catch up after treatment, not growing really good due to the bones due to skeletal dysplasia
what are the features of Prader-Willi Syndrome?
- Infantile hypotonia/feeding problems
- Hyperphagia/obesity in childhood
- Short stature
- Developmental delay/
- Hypogonadism
- Deletion of 15q11-q13 chromosomal region
can give growth hormone
what are the features of Noonan’s syndrome?
- Typical facial features
- Short stature
- Congenital heart disease (pulmonary valve stenosis)
can benefit from GH
what is Achondroplasia?
lots of skeletal dysplasia but this is the most common one, very short limbs as long bones don’t grow properly, GH doesn’t work on these children
Achondroplasia is a disorder of bone growth that prevents the changing of cartilage (particularly in the long bones of the arms and legs) to bone. It is characterized by dwarfism, limited range of motion at the elbows, large head size (macrocephaly), small fingers, and normal intelligence
