Paediatric Growth & Endocrine Flashcards
What factors can infleunce a childs hight?
Age
Sex
Race
Nutrition
Chronic disease
Specific growth disorders
What are the different stages of normal growth?
Infantile
Childhood
Pubertal
During which stage of growth is the sharpest decrease in rate of height gain per year?
Infancy
During which stage of growth is the sharpest increase in rate of height gain per year?
Puberty
What is the measurement used to determine growth in infancy?
Length
What is the measurement used to determine growth in childhood?
Height
What is the name of the standard growth chart used in the UK?
RCPCH UK 2-18 Growth chart
What are the growth assessment tools used to assess child development?
Growth charts and plotting
Mid Parental Height
Childs height/length
Bone age
What are some indications for referal for growth disorders?
- Extremes of height (short or tall)
- Height below target height
- Abnormal height velocity
- Earyly/late puberty
What are the common causes of short stature?
Familial
Constitutional
SGA/IUGR (small for gestational age/intra-uterine growth restriction)
What is meant by constitutional growth delay?
A temporary delay in skeletal growth
What is familial short stature?
When a child is growing at their normal/predicted growth rate but both parents are of short stature (mother < 5’1, father < 5’5)
What are some pathological causes of short stature?
1 - Undernutrition
2 - IBD, Coeliac, Juvenille Chronic arthritis
3 - Steroids
4 - Turner syndrome
5 - Prader-willi syndrome
What are common investigations carried out to investigate growth disorders?
1 - FBC & Ferritin
2 - U&E’s
3 - LFT’s
4 - CRP
5 - Karyotype
Which method is used to compute the stage of puberty?
Tanner method
What are the components of the Tanner staging method?
Breast development
Genital development
Pubic hair
Axillary hair
Testes volume
At what age do male testes start to grow?
12 years
At what age do the female breasts begin to bud?
11 years
Male puberty at which age is considered early?
< 9
Male puberty at which age is considered delayed?
> 14 (CDGP)
Female puberty at which age is considered early?
< 8
Female puberty at which age is considered to be delayed?
> 13
In which sex is CDGP more common?
Boys
What is central precocious puberty?
Early sexual development in boys and girls
What are the features of central precocious puberty?
- Early development of breasts and testes
- Growth spurts
- Advanced bone age
What is precocious pseudopuberty?
Abnormal sex steroid hormone secretion (estrogen in girls and testosterone in boys)
What happens to the level of FSH and LH in precocious pseudopuberty?
Unaffected
What are the characteristic features of someone with precocious pseudopuberty?
Secondary sexual characteristics:
Boys - genital enlargement and pubic hair before 9.5 years
Girls - Breast enlargement before 7
At what Tanner stage do female breasts start budding?
B2
At what Tanner stage do boys testicles start enlarging?
G2
T 3-4ml
What are some common endocrine problems affecting childhood growth?
Congenital hypothyroidism
Acquired hypothyroidism - Autoimmune thyroiditis most common
What are the issues encountered during childhood relating to acquired hypothyroidism?
1 - Lack of height gain
2 - Delay in puberty
3 - Poor school performance
What are the symptoms of Type 1 diabetes in childhood?
Thirsty
Thinner
Tired
Using Toilet more often
If Type 1 diabetes is suspected in a child, what test must be performed immediately?
Finger prick capillary glucose test
What result from a finger prick capillary glucose test indicates urgent help is required?
> 11 mmol/l
What is a red flag symptom that could indicate Type 1 diabetes in a child?
A return to bed wetting after having been dry
What are the symptoms of DKA?
Nausea & vomitting
Abdo pain
Sweet smelling breath
Drowsiness
Rapid, deep breathing
Coma
