Paediatric Growth and Endocrinology Flashcards
1
Q
Normal growth varies due to what?
A
- Ethnic groups
- Inequality in basic health and nutrition
- Genetic influence
2
Q
What are investigations for assessing growth?
A
- 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
3
Q
Summarise assessment tools for growth and pubertal development?
A
- Height/length/weight
- Growth charts and plotting
- MPH and target centiles
- Growth velocity
- Bone age
- Pubertal assessment
4
Q
What are indications for referral for growth disorders?
A
- 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
5
Q
Short stature - aetiology
A
- Familial
- Constitutional delay of growth and puberty
- Younger bone age, ‘late developer’
- SGA/IUGR
6
Q
Short stature - investigations
A
- IGF-1 often low
- Perform GH stimulation test
- Arginine test
- Insulin tolerance test
- Perform GH stimulation test
7
Q
Growth hormone deficiency - investigations
A
- MRI of pituitary gland
- Small anterior pituitary gland
- Ectopic posterior pituitary gland
8
Q
Growth hormone deficiency - clinical features
A
Small stature
9
Q
Growth hormone deficiency - treatment
A
- Growth hormone replacement
10
Q
What can puberty be assessed by?
A
Tanner staging
11
Q
Describe tanner staging?
A
- 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
12
Q
What hormones are released during puberty?
A
Boys - testosterone
Girls - estradiol
13
Q
Compare the relationship between growth and other changes in puberty in boys and girls?
A
14
Q
When is puberty late and early in:
- boys
- girls
A
- Boys
- Early <9 years (rare)
- Delayed >14 years (common)
- Girls
- Early <8 years
- Delayed >13 years (rare)
15
Q
What does CDGP stand for?
A
Constitutional delay of growth and puberty
16
Q
CDGP - epidemiology
A
Mainly boys
17
Q
CDGP - clinical features
A
- FH in dad or brothers
- Bone age delay
18
Q
Abnormal growth and pubertal development - aetiology (pathological)
A
- Undernutrition
- Chronic illness
- JCA, IBD, coeliac
- Iatrogenic
- Steroids
- Psychological and social
- Hormonal
- GHD, hypothyroidism, glucocorticoid excess
- Syndromes
- Turner, P-W, Noonan, PHPT
- Skeletal dysplasias
19
Q
Thyroid deficiency - clinical features
A
- Suddenly drops growth trajectory lines
20
Q
Turners syndrome - aetiology
A
- Genetic - 45X
21
Q
Turners syndrome - clinical features
A
- Short stature
- Ovarian dysgenesis
- Associated disorders
- Cardiac, renal, thyroid, ENT problems
- Psychosocial/education difficulties
- Physical stigmata
22
Q
Turners syndrome - management
A
- Growth hormone replacement
23
Q
Prader-Willi syndrome - aetiology
A
- Deletion of 15q11-q13 chromosomal region
24
Q
Prader-Willi syndrome - clinical features
A
- Infantile hypotonia/feeding problems
- Hyperphagia/obesity in childhood
- Short stature
- Developmental delay
- Hypogonadism
25
Prader-willi syndrome - management
* Growth hormone replacement
26
Noonan syndrome - clinical features
* Typical facies
* Spaced eyes
* Short stature
* Congenital heart disease
* Often pulmonary valve stenosis
27
Achondroplasia - clinical features
* Short limbs
* Short stature
28
Achondroplasia - management
* Growth hormone DOES NOT work
29
Psychosocial growth disturbance - clinical features
* Stop growing due to being abused or poor social circumstances
30
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
31
Early sexual development - aetiology
32
Central precocious puberty - clinical features
* True pubertal development
* Breast development in girls
* Testicular enlargement in boys
* Growth spurt
* Advanced bone age
33
Central precocious puberty - investigations
* MRI
* Exclude pituitary lesion
34
Precocious pseudopuberty - clinical features
* Secondary sexual characteristics
* Gonadotrophin independent
* Low levels of LH and FSH
* Early menarche (most common)
35
Obesity - aetiology
* Syndrome
* Hypothalamic-pituitary pathology
* Endocrinopathy
* Diabetes
* Drugs
* Poor diet (most common)
* Refer to dietician
36
Obesity - assessment
* Weight
* BMI
* Kg/m2
* Changes with age for children
* Height
* Skin folds
37
Simple obesity - treatment
* Diet
* Exercise
* Psychological input
* Maybe drugs but not often in childhood
38
Other than simple obesity, what are other causes of obesity?
39
Diabetes - classification
* Type 1 diabetes
* Type 2 diabetes
40
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
41
T1 diabetes - management
* Early diagnosis
* DKA prevention
* Manage blood sugars
42
Diabetic ketoacidosis - presentation
* Nausea and vomiting
* Abdominal pain
* Sweet smelling “ketotic” breath
* Drowsiness
* Rapid, deep “sighing” respiration
* Coma
43
Diabetic ketoacidosis - investigations
* Finger prick capillary blood glucose test
* \>11moll/L – diabetes
* \<11mmol/L – other cause
