The Endocrine Exam Flashcards
what is growth and final height dependent on?
familial factors (parent height)
congenital conditions (skeletal dysplasia, chromosomal disorders
IUGR
constitutional delay of growth and puberty
chronic systemic disorders
endocrine disorders
environmental issues
what are some endocrine disorders that cause short stature
hypothalamus (true precocious puberty)
pituitary (growth hormone deficiency)
traget Organs (hypothroidism and cushings)
target tissues (Aaron type dwarfism)
IGF interactions (reduced IGF response)
how do you examine a child for growth
look for evidence of disproportion (either short legs or short trunk in relation to standing height)
how do you calculate sub-ischial leg length
measure sitting height and subtract that from standing height
how can you calculate mid parental height
for girls: (father’s height + mother’s height) divided by 2 then subtract 7.
for boys: (father’s height + mother’s height) divided 2 plus 7
how do you calculate mid-parental centile
plot the child’s adult height potential on the chart and the nearest centile line is the 500th centile, known as the mid-parental centile
what is the target centile range
the child’s curve would be expected to follow a centime somewhere between the ninth and 91st centile (mid parental height plus or minus 8.5 cm)
how can you classify a child in to four groups
- A dysmorphic child with a recognisable syndrome
- Disproportionate short stature
- Short but Thin
- short and fat
what are some recognisable syndrome in short children
turner’s syndrome
downs syndrome
noonans syndrome
Russell- silver syndrome
prader willi syndrome
what causes of short back and limbs
spondyloepiphyseal dysplasia
mucopolysaccharidoses
metetrophic dwarfism
what are some cause of short limbs
achondroplasia
hypochondroplasia
metaphysical chondroplasia
what are the causes of a short but thin child
think chronic disease
CVD, respiratory (CF)
malabsorption (coeliac)
chronic inflammatory bowel disease
renal (chronic renal failure)
deprivation/ anorexia
what are causes of short and fat children
panhypopituitarism
isolated growth hormone deficiency
hypothyroidism
pseudohypoarathyroidism
Cushing syndrome
what are you looking for inspection of the thyroid
is there a goitre?
is there a thyroglossal cyst
is there a thyroidectomy scar?
who do you inspect for a goitre
ask the child to sit with chin slightly elevated, ask the child to sip a cup of water as a goitre will be seen to elevate
how do you inspect for a thyroglossal cyst
ask the child to stick out their tongue
how do you palpate the thyroid
always examine the thyroid from behind,
palpate lightly with the fingertips to define the upper and lower borders of the lateral lobes
the consistency of the gland
thyroglossal cysts are in the midline and tend to be fluctuant
the movement of the gland
enlarged cervical lymph nodes
how do you check the movement of the gland
confirm that the gland, which is attached to the pretracheal fascia moves when the child swallows some water
a thyroglossal cyst moves upwards on protrusion of the tongue retrosternal extension and tracheal devotion should be examined by palpating the suprasternal notch
what are you auscultating for
a systolic bruit may be heard in a diffuse toxic goitre
features of hypothyroidism- history
history: slow growth and pubertal delay
cold intolerance, poor concentration/ deterioration in school work, learning difficulties, and constipation
features of hypothyroidism- exam
general: short star, delayed puberty, obesity, slow speech, thought and movement
face: pale puffy eyes with loss of eyebrows
thin dry hair
dry skin
pulse: bradycardia
hands- cold peripheries
reflexes: delayed
cause of hypothyroidism
autoimmune thyroiditis
what is the common cause of hyperthyroidism
graves disease
features of hyperthyroidism: history
anxiety and restlessness
sweating and weight loss
thin
increased appetite
rapid growth in height with advancement of been age
heat intolerance
learning difficulties or behavioural issues
features of hyperthyroidism- examination
general: hyperpigmentation, vitiligo, pre tibial myxoedema
hands; fine tremor, warm and sweaty, tachycardia
neck- goitre with bruit
eye signs: exophthalmos. lid retraction, lid lag, ophthalmoplegia
cardiac: hyperactive precordium and ejection systolic murmur, increased BP
neurological- proximal muscle weakness
how do you test for lid lag
ask the child to follow the movements of your finger slowly upwards and downwards. The sclera becomes visible above the Irish on downward gaze as the eyelid is slow to follow the movement of the eye
what are the features of pseudo-precocious puberty in girls
they have features of androgenisation (pubic and axillary hair and clitoromegaly)
what are tow important causes of pseudo precocious puberty in girls
congenital adrenal hyperplasia (21 hydroxylase deficiency)
virilizing adrenal tumour
what are the features of true precocious puberty in girls?
oestrogenisation and androgenisation (breast development, menstration, pubic and axillary hair but no clitoromegaly
what are the causes of true precocious puberty in girls
90% caused by idiopathic premature activation of the HPG axis
other: CNS tumours, hydrocephalous, post-meningitis, hypothryoidism, specific syndromes
what specific syndrome cause precocious puberty
neurofibromatosis
tuberous sclerosis
albright syndrome
what is the triad of albirghts syndrome
true precocious puberty, polyostotic dysplasia of the bones, and areas of skin pigmentation
what are you thinking about in precocious puberty in boys
that it is uncommon and likely to be pathological
if the testes are less than 4 mL what does that suggest (in the context of symptoms of precocious puberty)
pseudo precocious puberty due to extragondal secretion
what are the causes of pseudo precocious puberty
adrenal tumour and adrenal hyperplasia
if the testes are are of greater than 4mL in the context of precocious puberty what does that suggest
true precocious puberty due to gonadotropin secretion from the pituitary
what are the causes of true precocious puberty in boys
CNS tumour (pineal, hypothalamic, pituitary)
hydrocephalous
post meningitis
hypothyroidism
specific syndrome (same as girls minus Albright)
idiopathic premature activation of the HPG axis (about 50% of cases)
what is the exception to the rule of using testicular volumes to determine if true or pseudo precocious puberty?
in HCG secreting tumours, hepatoblastoma and teratoma may secrete gonadotropins which will cause enlargement of the testes and androgenisation from Leydig cell stimulation.
what are the causes of tall stature
associated with symorphic features: MArfans. homocystinuria, cerebal gigantism, beck with- weidermann syndrome, klineflelters syndrome
endocrine: pituitary gigantism, thyrotoxicosis, precocious puberty, adrenal disease
