Pediatric Endocrine Newman

Question 1

From 6 yo to puberty, how much should a kid be growing in a year?

Answer 1

2 inches (5cm)

Question 2

What is bone age? What is considred delayed?

Answer 2

• provides a rough estimate of kids skeletal maturation by looking at ossification around the epiphyseal centers
• bone age that is two standard deviations below chronologic age is considered delayed

Question 3

What is the “catch up” or “catch down” growth?

Answer 3

• kids can make up to a 25% downward correction on the growth curve in weight, often as table food is introduced
• after 24 monnths they usually foolow the same curve until puberty

Question 4

How would a child’s bone analysis look on a child who is following a constitutional growth delay ?

Answer 4

Less than chronological age because they still have some developing to do

Question 5

What would a bone analysis look like on a child who is going through precocious puberty

Answer 5

around 6-8 yo the bone age would be greater than chronological

Question 6

How do you evaluate growth on a child who is less than 36 months?

Answer 6

• measure length while the kid is supine

Question 7

How do you evaluate growth on a kid older than 24 months?

Answer 7

has to be standing up

Question 8

short stature definition?

Answer 8

• height is two standard deviations below the mean height for age and sex <3%ile
• Height more than 2 std dev below mid parental height

Question 9

What are benign causes of short stature?

Answer 9

• constitutional growth delay
• familial short stature
• idiopathic

Question 10

Pathologic causes of short stature?

Answer 10

• endocrine
• genetic syndromes
• nutritional disorders
• chronic illness/drugs

Question 11

What particular test is important if you are working up a child for short stature?

Answer 11

IGF and IGFBP-3 levels

Question 12

Cushing disease?

Answer 12

• oversecretion of ACTH from pituitary, primary adrenal tumor or rarely ectopic source of ACTH
• PE:
  
  • obesity, moon facies, striae, cessation of linear growth
• Lab:
  
  • midnight serum cortisol
  • dexamethasone suppression test

Question 13

With delayed puberty and short stature in a female, what should always be checked?

Answer 13

Karyotype

Question 14

Precocious puberty is defiined as….?

Answer 14

full activation of HPG axis before 8 years of age in girls and before 9 in boys

Question 15

When do you consider precocious puberty as a diagnosis in girls?

Answer 15

• progressive breast development
• crossing major percentile lines up on linear growth chart

Question 16

When do you consider precocious puberty in boys?

Answer 16

• evidence of both testicular and penile enlargement
• crossing major percentile lines up on the linear growth chart

Question 17

the appearance of ____ is associated with an increases in DHEA and DHEA-S, and the patient will have a normal rate of linear growth and no clitoromegaly, penile growth, or testicular enlargement.

Answer 17

Appearance of pubic hair, axillary hair, odor, mild acne

Question 18

Severe hypothyroidism in kids?

Answer 18

Increase BMI from growth arrest with continued weight gain

Question 19

What pathologies can cause tall stature?

Answer 19

• Beckwith-Wiedemann
• GH excess → gigantism
• Homocystinuria
• Infant of diabetic mom
• Klinefelter syndrome
• Marfan

Question 20

6 yo you haven’t seen in 2 years is brought in with the concern he isnt growing as fast as other kids at school. Mom wonders if its asthma medication studnting his growth. No ill recently asthma well controlled. Eating and drinking well, no diarrhea vomiting. Sleeps well at night. What is first step?

Answer 20

Look at previous growth curve

Question 21

6 yo you haven’t seen in 2 years is brought in with the concern he isnt growing as fast as other kids at school. Mom wonders if its asthma medication studnting his growth. No ill recently asthma well controlled. Eating and drinking well, no diarrhea vomiting. Sleeps well at night.

What could cause his pattern of growth?

Answer 21

• constitutional or familial growth
• endocrine (usually not symmetric the whole time)
• genetic
• nutrition
• chronic disease
• inhaled corticosteroids (usually only impacts growth for first year then they catch up)

Question 22

What is a healthy BMI range?

Answer 22

18.5-24.9

Question 23

What is the first growth parameter affected in endocrine growth disorders?

Answer 23

Length/Height

Question 24

If height changes first or most dramatically on a growth curuve think _____, if weight changes first or most dramatically think _____.

Answer 24

If height changes first or most dramatically on a growth curuve think endocrine** if weight changes first or most dramatically think **calories/ nutrition.

Question 25

Decreased levels of IGF-1 and IGFBP-3 levels are consistent with what type of deficiency?

Answer 25

Growth hormone