Paediatric Growth and Endrocrine

Question 1

What is normal growth?

Answer 1

• 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)

Question 2

What factors can influence height?

Answer 2

• Age
• Sex
• Race
• Nutrition
• Parental heights
• Puberty

Question 3

What assessment tools can we use to assess development?

Answer 3

• Height/Weight/length
• Growth charts and plotting
• MPH (mid parental height) and target centiles
• Growth velocity
• Bone age
• Pubertal assessment

Question 4

What are indicators for referral from growth disorders?

Answer 4

• Extreme tall or short
• Height below target height
• Abnormal velocity
• History of chronic disease
• Obvious dysmorphic sundrome

Question 5

Pathological causes of short stature?

Answer 5

• Undernutrition
• Chronic illness
• Iatrogenic (steroids)
• Hormonal
• Turner syndrome

Question 6

Explain tanner staging of puberty:

Answer 6

• B: Breast development (1 to 5)
• G: Genital development (1 to 5)
• PH: pubic hair (1 to 5)
• AH: Axillary hair (1 to 3)
• T: testes 2-20ml

Question 7

What is early/delayed puberty for male and female?

Answer 7

Boys

• <9 is early
• >14 is delayed

Girls

• <8 is early
• >13 is delayed

Question 8

What is main cause of delayed puberty?

Answer 8

Constitutional delay of growth and puberty (CDGP)

Question 9

What is central precocoius puberty?

Answer 9

Causes EaRLY sexual development

• Causes breast growth gals and testes growth lads
• Growth spurt
• Advanced bone age
• NEED to exclude pituitary lesion

Question 10

What is precocious pseudopuberty?

Answer 10

• Abnormal sex steroid hormone secretion
• Gonadotrophin independent (low levels of LH and FSH)
• Clinical picture: 2ndary sexual characteristics
• Need to exlude congenital adrenal hyperplasia

Question 11

How do we manage ambigious genitalia?

Answer 11

• 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 12

What is most common cause of acquired hypothyroidism?

What issues may child have?

Answer 12

• Hashimotos (autoimmune thyroiditis)
• FH
• Lack of height gain, pubertal delay, poor school performance

Question 13

How do we assess obesity?

Answer 13

• Weight
• BMI
• Height
• Waist circumference
• Skin folds

Question 14

Obese + ……… = abnormal

Answer 14

SHORT

Question 15

What are causes of obesity?

Answer 15

• Simple obesity: increased intake and decreased exercise
• Drugs
• Endocrine disorders = associated growth failure
• Hypothalamic damage = loss of appetite control

Question 16

What is the treatment for obesity?

Answer 16

• Diet
• Exercise
• Psychological input

Question 17

Epidemiology of Type1 DM?

Answer 17

• Sco has 5th highest incidence worldwide of T1
• 1/4 diagnosed with DKA
• DKA is preventable so early diagnosis is key

Question 18

How can we make an early diagnosis of DM?

Answer 18

THINK symptoms

• Thirsty
• Thin
• Tired
• using Toilet more

TEST - immediately

• Finger prick capillary glucose test, >11mmol/l
• Don’t do any other test once have this result

TELEPHONE - urgently

• Contact local specialist team for same day review

Question 19

SSx for DKA?

Answer 19

• Nausea and vomming
• Abdo pain
• Ketotic breath - sweet smelling
• Drowsiness
• Rapid, deep sighing breathing
• Coma