Peds Endocrine

Question 1

What information is gathered by a single point on a growth chart?

Answer 1

Only gives information about how the child plots on the curve that day; need multiple points to evaluate the growth pattern (only way to evaluate if the rate of growth is adequate)

Question 2

What is considered a normal BMI?

Answer 2

18.5-24.9

Question 3

What is the normal growth velocity for school age children (ages 5 to puberty)?

Answer 3

5cm/year (2in/year)

Question 4

What is the first parameter MC affected in children with endocrine growth disorders?

Answer 4

Length or height

Question 5

What is considered to be a delayed bone age?

Answer 5

A bone age that is 2 standard deviations or more below the chronological age of the pt

Question 6

What growth parameters are included on a growth chart?

Answer 6

Height/length, weight, BMI, and head circumference

Question 7

If weight is the parameters that changes first or most dramatically on the growth chart what should you think of?

Answer 7

Think calories/nutrition (not getting fed enough, not retaining calories due to GERD or malabsorption, higher metabolic demands due to hyperthyroidism, congenital heart dz, etc)

Question 8

If head circumference is the parameters that changes first or most dramatically on the growth chart what should you think of?

Answer 8

Think brain/skull or hydrocephalus

Question 9

What is the definition for short stature?

Answer 9

Height that is >2 SDs below the mean height for age and sex (height would be in the 3rd percentile on the growth chart)

Question 10

What are familial cause of short stature?

Answer 10

Parents are small; grows with normal velocity in all parameters but plot lower on the growth curve and end height is consistent with mid parental height; bone age is consistent with chronological age

Question 11

What are constitutional causes of short stature?

Answer 11

Grow at a low normal rate and plot low on the growth curve; puberty is delayed; usually a FHx of late bloomers; puberty and growth spurts occur later, end height is normal; the hallmark of constitutional delay is delayed bone age

Question 12

What are idiopathic cause of short stature?

Answer 12

Height greater than 2 SD below the mean height for that age; no endocrine, metabolic or other dx present; no FHx of short stature; bone age is consistent with chronological age

Question 13

What is IGF-1?

Answer 13

A hormone that functions as the major mediator of GH stimulated somatic growth

Question 14

What is IGFP3?

Answer 14

Main IGF-1 transport protein in the blood stream

Question 15

What increases IGF-1 synthesis?

Answer 15

GH through osteoblast and chondrocytes suggesting that it contributes to statural growth

Question 16

What would the levels of IGF-1 and IGFBP3 be in a person with short stature?

Answer 16

Decreased levels of IGF-1 and IGFBP3 levels are consistent with GH deficiency

Question 17

What should be performed if IGF-1 and IGFBP3 levels are decreased?

Answer 17

GH stimulation testing should be performed via administration of glucagon, administration of arginine or insulin induced hypoglycemia

Question 18

What is precocious puberty?

Answer 18

The onset of secondary sexual characteristics before 8 yo in girls and before 9 yo in boys

Question 19

What are additional findings used to make the dx of precocious puberty?

Answer 19

In girls: progressive breast development and crossing major percentile lines upward on the linear growth chart; in boys: evidence of both testicular and penile enlargement and crossing major percentile lines upward on the linear growth chart; rate of growth is fast initially but overall end height is less than it would normally be

Question 20

What is the work up for suspected precocious puberty?

Answer 20

Complete Hx and PE, labs (LH, FSH, estradiol/testosterone, 17-hydroxyprogesterone), imaging (bone age, MRI of the head, US of gonads)

Question 21

What are the dysmorphic features of Turner syndrome?

Answer 21

Short stature, wide shield shaped chest, wide spaced hypoplastic nipples, excess skin at back of neck/webbed neck, gonadal dysgenesis (streak ovaries by puberty), horseshoe kidney, congenital heart dz

Question 22

What causes premature adrenarche?

Answer 22

A benign condition caused by early maturation of zona reticularis of the adrenal gland with associated increased androgen secretion

Question 23

When is a work up warranted for a pt with premature adrenarche?

Answer 23

In pts with premature pubarche, when associated with other secondary sex characteristics and or bone age advanced >2SD from the normal age, when associated with significant growth acceleration

Question 24

Whether benign or associated with precocious puberty, a pt with premature adrenarche should be what?

Answer 24

Monitored clinically closely

Question 25

When is a work up warranted in a pt with premature thelarche?

Answer 25

When associated with other signs of secondary sex maturation, if associated with accelerated growth, when the bone age is advanced beyond 2 SD for the age

Question 26

What is congenital hypothyroidism?

Answer 26

Inadequate thyroid hormone production in newborn infants; secondary to absence, dysgenesis, or abnormal function of the thyroid gland

Question 27

What are the sx of congenital hypothyroidism?

Answer 27

Hoarse cry, course facies, lethargy, feeding problems, constipation, macroglossia, large fontanelles, hypotonia, prolonged jaundice

Question 28

What is the MCC of acquired hypothyroidism?

Answer 28

Autoimmune thyroiditis

Question 29

What are the clinical manifestations of autoimmune thyroiditis?

Answer 29

Declining grwoth velocity/short stature, abnormal pubertal development, declining school performance, sluggishness, fatigue, cold intolerance, constipation, dry skin, brittle hair, facial puffiness, muscle aches

Question 30

What is the primary determinant of normal post natal growth and skeletal maturation?

Answer 30

T3

Question 31

What is an important regulator of bone and mineral metabolism in older children and adults?

Answer 31

T3

Question 32

What does bone age assessment provided?

Answer 32

A rough estimate of a child’s skeletal maturation by assessing the ossification of the epiphyseal centers

Question 33

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

Answer 33

Occurs in the first 18 months of life; some kids make up to a 25% downward correction on the growth curve (often occurs as more table food is introduced)

Question 34

If a child is less than 36 mo of age how should length be measured?

Answer 34

Using the 0-36 month curve, length is measured while the child is supine

Question 35

How should height be measured in a child that is older than 24 mo?

Answer 35

May use the 2-20 yo chart but the height must be measured standing up (stature)

Question 36

With delayed puberty/short stature in females, what should always be checked?

Answer 36

A karyotype

Question 37

Can short stature occur in the absence of other clinical features?

Answer 37

Yes