Pediatric Endocrine Newman Flashcards
From 6 yo to puberty, how much should a kid be growing in a year?
2 inches (5cm)
What is bone age? What is considred delayed?
- 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
What is the “catch up” or “catch down” growth?
- 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
How would a child’s bone analysis look on a child who is following a constitutional growth delay ?
Less than chronological age because they still have some developing to do
What would a bone analysis look like on a child who is going through precocious puberty
around 6-8 yo the bone age would be greater than chronological
How do you evaluate growth on a child who is less than 36 months?
- measure length while the kid is supine
How do you evaluate growth on a kid older than 24 months?
has to be standing up
short stature definition?
- 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
What are benign causes of short stature?
- constitutional growth delay
- familial short stature
- idiopathic
Pathologic causes of short stature?
- endocrine
- genetic syndromes
- nutritional disorders
- chronic illness/drugs
What particular test is important if you are working up a child for short stature?
IGF and IGFBP-3 levels
Cushing disease?
- 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
With delayed puberty and short stature in a female, what should always be checked?
Karyotype
Precocious puberty is defiined as….?
full activation of HPG axis before 8 years of age in girls and before 9 in boys
When do you consider precocious puberty as a diagnosis in girls?
- progressive breast development
- crossing major percentile lines up on linear growth chart
When do you consider precocious puberty in boys?
- evidence of both testicular and penile enlargement
- crossing major percentile lines up on the linear growth chart
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.
Appearance of pubic hair, axillary hair, odor, mild acne
Severe hypothyroidism in kids?
Increase BMI from growth arrest with continued weight gain
What pathologies can cause tall stature?
- Beckwith-Wiedemann
- GH excess → gigantism
- Homocystinuria
- Infant of diabetic mom
- Klinefelter syndrome
- Marfan
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?
Look at previous growth curve
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?
- 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)
What is a healthy BMI range?
18.5-24.9
What is the first growth parameter affected in endocrine growth disorders?
Length/Height
If height changes first or most dramatically on a growth curuve think _____, if weight changes first or most dramatically think _____.
If height changes first or most dramatically on a growth curuve think endocrine** if weight changes first or most dramatically think **calories/ nutrition.
