Scenario 22: Puberty Flashcards
How do we construct a growth chart?
Define the reference population, decide whether longitudinal or cross-sectional. Use centiles.
Why do we need new growth charts?
‘Secular trend’, the obesity epidemic, based on worldwide data not just UK, based on breast-fed infant population, describe optimal rather than average growth
How do growth rates before puberty relate to the timing of puberty?
Faster developers or overweight children often hit puberty earlier, slower developers or underweight children later
What is the best measure of the tempo of growth?
The bone age viewed by an x-ray of the left hand and wrist. View the growth plate where GH and IGF1 and other transcription factors act. Uses skeletal maturity scoring system
What are the Tanner stages?
Stages of breast development, pubic and axillary hair, penis and scrotum development, testicular volume
What is the Prader Orchidometer?
The string of beads used to size the testes to assess their development
How can we predict the adult height of a child?
Plot parental target height. Plot height of parent of same sex as child on chart and opposite sex (+12.5cm for mother of boy, -12.5cm for father of girl) target height is the mid point between the 2 parents
When may ‘crossing centiles’ be normal?
In infants- to catch up or catch down growth
In puberty- early or delayed developers
What are some key points relating to short stature?
Birth weight, nutrition and feeding in infancy, other physical abnormalities, developmental history, evidence of recent growth failure
How does family history relate to short stature?
Ethnic origin, parental stature, parental nutrition, parental disproportion, pubertal development of parents
What may cause a low birth weight?
Prematurity, chromosomal/genetic abnormalities, inter-uterine infection, other toxins (e.g. foetal alcohol syndrome)
What are the features of Silver-Russel syndrome?
Prenatal growth failure, no post-natal catch up growth, skeletal abnormalities (limb asymmetry, incurved 5th finger), small triangular face, normal HC
What are some severe syndromes causing short stature?
Seckel, Delange, Rubinstein-Taybi, Smith-Lemli-Opitz
What are some moderate syndromes causing short stature?
Williams, Prader-Willi, Noonans
What would a marked delay in bone age signal?
Hormone deficiency, delayed puberty
What would a moderate delay in bone age signal?
Chronic disease, psychosocial issues,
What would a normal delay in bone age signal?
IUGR syndromes, bone dysplasias
What would an advancment in bone age signal?
Obesity, sexual prcocity, sex hormone excess
How does acquired hypothyroidism present?
Somewhat overweight, elevated TSH, small thyroid, short stature
What are the symptoms of coeliacs disease in children?
Short, thin, tired, anaemic, positive antibodies, negative jejunal biopsy, response to diet
What may cause a short spine in children?
Spinal anomlay, scoliosis, SED, irradiation, haemoglobinopathy
What may cause short legs in children?
Hypothyroid, rickets, skeletal dysplasia, turner syndrome
What may cause long legs in children?
Klinefelter’s syndrome, delayed puberty
What are the signs of Turner syndrome?
Short stature, abnormal upper/lower segment ratio, high palate, small jaw, cubitus valgus, short metacarpals, webbing, oedema,
