The Endocrine Exam

Question 1

what is growth and final height dependent on?

Answer 1

familial factors (parent height)
congenital conditions (skeletal dysplasia, chromosomal disorders
IUGR
constitutional delay of growth and puberty
chronic systemic disorders
endocrine disorders
environmental issues

Question 2

what are some endocrine disorders that cause short stature

Answer 2

hypothalamus (true precocious puberty)
pituitary (growth hormone deficiency)
traget Organs (hypothroidism and cushings)
target tissues (Aaron type dwarfism)
IGF interactions (reduced IGF response)

Question 3

how do you examine a child for growth

Answer 3

look for evidence of disproportion (either short legs or short trunk in relation to standing height)

Question 4

how do you calculate sub-ischial leg length

Answer 4

measure sitting height and subtract that from standing height

Question 5

how can you calculate mid parental height

Answer 5

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

Question 6

how do you calculate mid-parental centile

Answer 6

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

Question 7

what is the target centile range

Answer 7

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)

Question 8

how can you classify a child in to four groups

Answer 8

1. A dysmorphic child with a recognisable syndrome
2. Disproportionate short stature
3. Short but Thin
4. short and fat

Question 9

what are some recognisable syndrome in short children

Answer 9

turner’s syndrome
downs syndrome
noonans syndrome
Russell- silver syndrome
prader willi syndrome

Question 10

what causes of short back and limbs

Answer 10

spondyloepiphyseal dysplasia
mucopolysaccharidoses
metetrophic dwarfism

Question 11

what are some cause of short limbs

Answer 11

achondroplasia
hypochondroplasia
metaphysical chondroplasia

Question 12

what are the causes of a short but thin child

Answer 12

think chronic disease
CVD, respiratory (CF)
malabsorption (coeliac)
chronic inflammatory bowel disease
renal (chronic renal failure)
deprivation/ anorexia

Question 13

what are causes of short and fat children

Answer 13

panhypopituitarism
isolated growth hormone deficiency
hypothyroidism
pseudohypoarathyroidism
Cushing syndrome

Question 14

what are you looking for inspection of the thyroid

Answer 14

is there a goitre?
is there a thyroglossal cyst
is there a thyroidectomy scar?

Question 15

who do you inspect for a goitre

Answer 15

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

Question 16

how do you inspect for a thyroglossal cyst

Answer 16

ask the child to stick out their tongue

Question 17

how do you palpate the thyroid

Answer 17

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

Question 18

how do you check the movement of the gland

Answer 18

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

Question 19

what are you auscultating for

Answer 19

a systolic bruit may be heard in a diffuse toxic goitre

Question 20

features of hypothyroidism- history

Answer 20

history: slow growth and pubertal delay
cold intolerance, poor concentration/ deterioration in school work, learning difficulties, and constipation

Question 21

features of hypothyroidism- exam

Answer 21

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

Question 22

cause of hypothyroidism

Answer 22

autoimmune thyroiditis

Question 23

what is the common cause of hyperthyroidism

Answer 23

graves disease

Question 24

features of hyperthyroidism: history

Answer 24

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

Question 25

features of hyperthyroidism- examination

Answer 25

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

Question 26

how do you test for lid lag

Answer 26

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

Question 27

what are the features of pseudo-precocious puberty in girls

Answer 27

they have features of androgenisation (pubic and axillary hair and clitoromegaly)

Question 28

what are tow important causes of pseudo precocious puberty in girls

Answer 28

congenital adrenal hyperplasia (21 hydroxylase deficiency)
virilizing adrenal tumour

Question 29

what are the features of true precocious puberty in girls?

Answer 29

oestrogenisation and androgenisation (breast development, menstration, pubic and axillary hair but no clitoromegaly

Question 30

what are the causes of true precocious puberty in girls

Answer 30

90% caused by idiopathic premature activation of the HPG axis
other: CNS tumours, hydrocephalous, post-meningitis, hypothryoidism, specific syndromes

Question 31

what specific syndrome cause precocious puberty

Answer 31

neurofibromatosis
tuberous sclerosis
albright syndrome

Question 32

what is the triad of albirghts syndrome

Answer 32

true precocious puberty, polyostotic dysplasia of the bones, and areas of skin pigmentation

Question 33

what are you thinking about in precocious puberty in boys

Answer 33

that it is uncommon and likely to be pathological

Question 34

if the testes are less than 4 mL what does that suggest (in the context of symptoms of precocious puberty)

Answer 34

pseudo precocious puberty due to extragondal secretion

Question 35

what are the causes of pseudo precocious puberty

Answer 35

adrenal tumour and adrenal hyperplasia

Question 36

if the testes are are of greater than 4mL in the context of precocious puberty what does that suggest

Answer 36

true precocious puberty due to gonadotropin secretion from the pituitary

Question 37

what are the causes of true precocious puberty in boys

Answer 37

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)

Question 38

what is the exception to the rule of using testicular volumes to determine if true or pseudo precocious puberty?

Answer 38

in HCG secreting tumours, hepatoblastoma and teratoma may secrete gonadotropins which will cause enlargement of the testes and androgenisation from Leydig cell stimulation.

Question 39

what are the causes of tall stature

Answer 39

associated with symorphic features: MArfans. homocystinuria, cerebal gigantism, beck with- weidermann syndrome, klineflelters syndrome
endocrine: pituitary gigantism, thyrotoxicosis, precocious puberty, adrenal disease