Paediatric Growth and Endocrinology Flashcards
Normal growth varies due to what?
- Ethnic groups
- Inequality in basic health and nutrition
- Genetic influence
What are investigations for assessing growth?
- Measure parents height for mid parental height to obtain target centile range and compare current trajectory on growth chart
- Measure height over time and plot on growth chart
- X-ray to determine bone age, plot bone age over time
Summarise assessment tools for growth and pubertal development?
- Height/length/weight
- Growth charts and plotting
- MPH and target centiles
- Growth velocity
- Bone age
- Pubertal assessment
What are indications for referral for growth disorders?
- 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
Short stature - aetiology
- Familial
- Constitutional delay of growth and puberty
- Younger bone age, ‘late developer’
- SGA/IUGR
Short stature - investigations
- IGF-1 often low
- Perform GH stimulation test
- Arginine test
- Insulin tolerance test
- Perform GH stimulation test
Growth hormone deficiency - investigations
- MRI of pituitary gland
- Small anterior pituitary gland
- Ectopic posterior pituitary gland
Growth hormone deficiency - clinical features
Small stature
Growth hormone deficiency - treatment
- Growth hormone replacement
What can puberty be assessed by?
Tanner staging
Describe tanner staging?
- Tanner staging
- Assessment by clinical examination
- B 1 to 5 (breast development)
- G 1 to 5 (genital development)
- PH 1 to 5 (pubic hair)
- AH 1 to 3 (axillary hair)
- T 2ml to 20ml
- Example of statement – B3 PH3 or G2 PH2 6/6
- 5 stages
- 1 s pre-puberty
- 2 is beginning of puberty
What hormones are released during puberty?
Boys - testosterone
Girls - estradiol
Compare the relationship between growth and other changes in puberty in boys and girls?
When is puberty late and early in:
- boys
- girls
- Boys
- Early <9 years (rare)
- Delayed >14 years (common)
- Girls
- Early <8 years
- Delayed >13 years (rare)
What does CDGP stand for?
Constitutional delay of growth and puberty
CDGP - epidemiology
Mainly boys
CDGP - clinical features
- FH in dad or brothers
- Bone age delay
Abnormal growth and pubertal development - aetiology (pathological)
- Undernutrition
- Chronic illness
- JCA, IBD, coeliac
- Iatrogenic
- Steroids
- Psychological and social
- Hormonal
- GHD, hypothyroidism, glucocorticoid excess
- Syndromes
- Turner, P-W, Noonan, PHPT
- Skeletal dysplasias
Thyroid deficiency - clinical features
- Suddenly drops growth trajectory lines
Turners syndrome - aetiology
- Genetic - 45X
Turners syndrome - clinical features
- Short stature
- Ovarian dysgenesis
- Associated disorders
- Cardiac, renal, thyroid, ENT problems
- Psychosocial/education difficulties
- Physical stigmata
Turners syndrome - management
- Growth hormone replacement
Prader-Willi syndrome - aetiology
- Deletion of 15q11-q13 chromosomal region
Prader-Willi syndrome - clinical features
- Infantile hypotonia/feeding problems
- Hyperphagia/obesity in childhood
- Short stature
- Developmental delay
- Hypogonadism
Prader-willi syndrome - management
- Growth hormone replacement
Noonan syndrome - clinical features
- Typical facies
- Spaced eyes
- Short stature
- Congenital heart disease
- Often pulmonary valve stenosis
Achondroplasia - clinical features
- Short limbs
- Short stature
Achondroplasia - management
- Growth hormone DOES NOT work
Psychosocial growth disturbance - clinical features
- Stop growing due to being abused or poor social circumstances
Delayed puberty - aetiology
- Chronic disease
- Crohn’s, asthma
- Constitutional
- Primary gonadal disorders
- Gonadal dysgenesis (Turner’s Klinefelter’s DSD)
- Testicular irradiation
- Impaired HPG axis
- Septo-optic dysplasia
- Craniopharyngioma
- Kallman’s syndrome
Early sexual development - aetiology
Central precocious puberty - clinical features
- True pubertal development
- Breast development in girls
- Testicular enlargement in boys
- Growth spurt
- Advanced bone age
Central precocious puberty - investigations
- MRI
- Exclude pituitary lesion
Precocious pseudopuberty - clinical features
- Secondary sexual characteristics
- Gonadotrophin independent
- Low levels of LH and FSH
- Early menarche (most common)
Obesity - aetiology
- Syndrome
- Hypothalamic-pituitary pathology
- Endocrinopathy
- Diabetes
- Drugs
- Poor diet (most common)
- Refer to dietician
Obesity - assessment
- Weight
- BMI
- Kg/m2
- Changes with age for children
- Height
- Skin folds
Simple obesity - treatment
- Diet
- Exercise
- Psychological input
- Maybe drugs but not often in childhood
Other than simple obesity, what are other causes of obesity?
Diabetes - classification
- Type 1 diabetes
- Type 2 diabetes
T1 diabetes - presentation
- 4Ts
- Thirsty
- Tired
- Thinner
- Using Toilet more
- In children under 5 also think
- Heavier than usual nappies
- Blurred vision
- Candidiasis (oral, vulval)
- Constipation
- Recurring skin infections
- Irritability, behavioural changes
T1 diabetes - management
- Early diagnosis
- DKA prevention
- Manage blood sugars
Diabetic ketoacidosis - presentation
- Nausea and vomiting
- Abdominal pain
- Sweet smelling “ketotic” breath
- Drowsiness
- Rapid, deep “sighing” respiration
- Coma
Diabetic ketoacidosis - investigations
- Finger prick capillary blood glucose test
- >11moll/L – diabetes
- <11mmol/L – other cause
