Paediatric growth , development and endocrine problems Flashcards
how is congenital hypothyroidism tested in neonates?
heel prick test
what are the 2 main causes of congenital hypothyroidism?
athyreosis (absence or functional deficiency of TH)
dyshormonogenic
what childhood problems can acquired hypothyroidism i.e. hashimotos cause in a child?
lack of height gain
pubertal delay
poor school performance
what are the causes of obesity in children?
simple obesity endocrine i.e. hypothyroidism drugs i.e. steroids syndromes i.e. turners hypothalamic damage
how would you assess an obese child?
height weight BMI skin folds waist circumference
what would you ask in the history of a child with obesity when trying to work out the cause?
diet physical activity FHx symptoms suggestive of; - syndrome (learning difficulties) - HPA pathology (lack of appetite control) - endocrinopathy (growth failure) - diabetes
give an examples of child specific complication can occur from childhood obesity?
slipped upper femoral epiphysis
polycystic ovarian syndrome
how might a child under 5 present with diabetes?
nappies more wet than usual irritability and behavioural changes blurred vision oral / vulvular thrush constipation recurrent skin infections
what are th symptoms of DKA?
abdominal pain nausea and vomiting ketonic / sweet breath rapid sighing breathing (kaussmaul sign) confusion altered consciousness coma
if you suspected diabetes in a child, what would be your next steps?
finger prick test for random blood glucose
if > 11mmol/L then urgent referral to specialist for same day review
don’t wait for blood tests, or fasting blood glucose or urinalysis!
act quickly!
what is a red flag sign for diabetes in children?
return to bed wetting when previously dry
what factors influence a childs height?
age sex nutrition parental height socio-economic status emotional wellbeing growth disorders race puberty skeletal maturity chronic disease
how would you measure a childs height?
length
height
head circumference
sitting height if concerns about disproportion
bone age
plot mid parental height and target gentile range
pubertal assessment
what are pathological causes of short stature?
undernutrition
chronic illness i.e. IBD, coeliac, asthma
iatrogenic i.e. steroids
psychological and social
hormonal i.e. growth hormone deficiency, hypothyroidism
syndromes i.e. turners, trader willi syndrome
if a child was found to be abnormally short for their age and you suspected a pathological cause, what investigations would you carry out to determine th cause?
FBC and ferritin - coeliac, crohns U&Es, LFTs, Ca, CRP coeliac serology and ida IGF-1, TFT, prolactin, FSH, LH karyotype - turners MRI
if a child was found to have low IGF-1, what investigation would you do next?
growth hormone stimulation test
determines if isolated GH deficiency
what is precocious pseudo puberty?
development of sexual characteritics very early due to a rapid rise in sex adrenal hormones but gonadotrophins (FSH and LH) are normal/low
what are causes of pubertal delay?
constitutional pubertal delay gonadal dysgenesis i.e. turners, kleinfelters chronic disease i.e. asthma, crohns impaired HPA i.e. kallmans syndrome peripheral i.e. cryptochordism
what tanner stages are used to identify central precocious puberty?
girls - breast development B2
boys - testicular volume 3-4ml + genital development G2
what are the stages in the tanner staging of puberty?
B - breast development 1-5 G - genital development 1-5 AH - axillary hair 1-4 PH - pubic hair 1-5 T - testicular volume 2-20ml
how do you determine testicular volume?
at what volume has a boy reached puberty?
orchidometre
3-4ml
what staging is used for pubertal development?
tanner staging
if a child has ambiguous genitalia, what condition would you want to exclude for the possible cause?
congenital adrenal hyperplasia
what could be a possible cause of precocious pseudo puberty?
congenital adrenal hyperplasia
if a child has central precocious puberty, what investigation would you carry out to test for a possible cause?
head MRI to exclude pituitary lesion
what is early and late puberty in a girl?
early < 8 years
late > 13 years
what is early and late puberty in a boy?
early < 9 years
later > 14 years
what is the first and last developmental stages in girls puberty?
first = breast development last = menarche
what is the first and late developmental stages in boys puberty?
first = testicular growth last = facial hair
when would you refer a child for investigations of their development?
extremely short or tall stature height below target abnormal height velocity history of chronic disease obvious dysmorphic features early or late puberty (girls < 8 or > 13, boys < 9 or > 14)
