Paediatric growth and endocrinology

Question 1

what is the shape of a normal growth graph? and what are the 3 main phases?

Answer 1

INFANTILE

CHILDHOOD

PUBERTAL

Question 2

what are some methods of measuring?

Answer 2

length

standing and sitting height

head circumference

then plot against norms

Question 3

how is plotitng of height done? and how are parental heights used?

Answer 3

The mid parental height is calculated in males, by adding 7cm to the mean of parental heights; in females by subtracting 7cm. This gives the height expected at 18 years for the child, and this can be plotted on the percentile chart to predict the child’s height at the appropriate age.

compared against normal percentiles

Question 4

what imaging is used for measureing growth?

Answer 4

xrays (identifies bone age and conditions such as osteopenia)

Question 5

what is asked in the hx of a child (in gerneral hx taking)?

Answer 5

birthweight and gestation issues?

PMH

FHX, SHC, schooling

systematic enquiry

dysmorphic assessment

exmaminaitona including pubertal assessment

Question 6

what are the assessment tools used by a practicioner - give a summary…

Answer 6

• Height/ length/ weight
• Growth Charts and plotting
• MPH and Target centiles
• Growth velocity
• Bone age
• Pubertal assessment

Question 7

what are the indications for referral in growth disorders?

Answer 7

• 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

Question 8

what are the common categories of short stature?

Answer 8

• Familial
• Constitutional (just naturally small with a delayed bone age, goes through puberty later)
• SGA/IUGR (small for uterine age/ intrauterine growth retardation)

Question 9

what are some pathalogical causes of short stature?

Answer 9

• Undernutrition
• Chronic illness (JCA, IBD, Coeliac)
• Iatrogenic (steroids)
• Psychological and social

•Hormonal (GHD, hypothyroidism)

•Syndromes (Turner, P-W)

Question 10

what Ix are done to determine what the cause of short stature is?

Answer 10

FBC and ferritin = General health, coeliac, Chron’s, JCA

U&E, LFT, Ca, CRP = General health, renal and liver disease, disorders of Ca metabolism

Coeliac serology and IgA = Coeliac disease

IGF-1, TFT, Prolactin, Cortisol, (gonadotrophins and sex hormones) = Hormonal disorders

Karyotype = Turner’s syndrome

Question 11

what is done in a GH stimulation Ix

Answer 11

arginine test

insulin tolerance test

Question 12

if there is an isolated growth hormone deficiency what is the next ix to be done?

Answer 12

MRI - may show ectopic posterior pit. gland OR small anterior pit. gland.

Question 13

what is the tx of growth hormone deficiency…pretty obvious

Answer 13

give growth hormone and monitor

Question 14

what height and weight changes are seen in hypothyroidism?

Answer 14

loss of height and gain in weight

Question 15

what are the sy/sx of Turners syndrome?

Question 16

what method is used to stage puberty

Answer 16

Tanner method

• 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 2 ml to 20 ml
• SO eg statement as B3 PH3 or G2 PH2 6/6

Question 17

what is used to measure testicular maturation?

Answer 17

Prader Orchidometer

Question 18

what age should you worry about early or delayed puberty in boys and girls?

Answer 18

• Boys - early < 9 years (rare), delayed >14 (common, especially CDGP)
• Girl - early <8 years, delayed >13 (rare)

Question 19

what is constitutional delay of growth and puberty (CDGP)

Answer 19

• Boys mainly
• Family history in dad or brothers (difficult to obtain!)
• Bone age delay
• Need to exclude organic disease

Question 20

Some other causes of delayed puberty

Answer 20

• Gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
• Chronic disease (Crohn’s, asthma)
• Impaired HPG axis (septo-optic dysplasia, craniopharyngioma, Kallman’s syndrome)
• Peripheral (cryptorchidism, testicular irradiation)

Question 21

precocious puberty

Answer 21

Abnormal sex steroid hormone secretion

• Gonadotrophin independent (low/prepubertal levels of LH and FSH)
• Clinical picture: secondary sexual characteristics

Need to exclude Congenital Adrenal Hyperplasia!

Question 22

Central Precocious Puberty

Answer 22

•Pubertal development

–Breast development in girls

–Testicular enlargement in boys

• Growth spurt
• Advanced bone age
• Need ro exclude a primary lesion - MRI done.

Question 23

Ambiguous genitalia: Management approach

Answer 23

• Do not guess the sex of the baby!
• Multidisciplinary approach (paed endo, surg, neonatologist, geneticist, psychologist)
• Exam: gonads?/ internal organs
• Karyotype
• Exclude Congenital Adrenal Hyperplasia!- risk of adrenal crisis is first 2 weeks of life

Question 24

what are the most common causes of acquired hypothyroidism?

Answer 24

autoimmune (hashimotos), fhx, = this will caue childhood issues (lack of height gain, pubertal delay, poor school performance).

Question 25

what does obese and abnormal mean?

Answer 25

the child is abnormal

Question 26

what is this?

what does it mean?

Answer 26

acanthosis nigricans

insulin resistance indicated by this

Question 27

causes of obesity in childhood?

Answer 27

• SIMPLE OBESITY
• Drugs
• Syndromes - learning difficulties
• Endocrine disorders - growth failure (short, fat)
• Hypothalamic damage - leads to loss of appetite control

Question 28

what are the symptoms of DM

Answer 28

Sometimes referred to as the 4T’s

Thirsty

Tired

Thinner

Using the Toilet more

Question 29

DKA symptoms

Answer 29

N and v

Abdo pain

ketotic breath,

drowsiness,

rapid, deep sighig resp - Kausmal Breathing

Coma

Question 30

Ix done for DM

Answer 30

Finger prick capillary blood glucose test

Result >11mmol/l - Diabetes

Result <11mmol/l - Other cause