17. Paediatric Endocrinology and Diabetes

Question 1

What Factors influence Height?

Answer 1

1. Age / Skeletal Maturity (Bone Age) / Puberty
2. Sex / Race / Parental Heights
3. General Health - Nutrition / Chronic Disease
4. Specific Growth Disorders
5. Socio-Economic Status
6. Emotional Well-Being

Question 2

What are the Different Techniques for Measuring Height?

Answer 2

1. Length
2. Height
3. Sitting Height
4. Head Circumference

Question 3

What needs to be looked for in a Paediatric History / Further Examination?

Answer 3

1. Birth Weight and Gestation
2. Past Medical History
3. Family / Social History / Schooling
4. Systemic Enquiry
5. Dysmorphic Features
6. Systemic Examination - including Pubertal Assessment

Question 4

What are the Assessment Tools used to Assess Growth?

Answer 4

1. Height / Length / Weight
2. Growth Charts and Plotting
3. Mean Parental Heights / Target Centiles
4. Growth Velocity
5. Bone Age
6. Pubertal Assessment

Question 5

What are the Indications for Growth Disorder Referral?

Answer 5

1. Extreme Short / Tall Stature
2. Height Below Target Height
3. Abnormal Height Velocity
4. History of Chronic Disease
5. Obvious Dysmorphic Syndrome
6. Early / Late Puberty

Question 6

What are the Common Causes of Short Stature?

Answer 6

1. Familial
2. Constitutional
3. Small for Gestational Age
4. Intra-Uterine Growth Restriction

Question 7

What are the Pathological Causes of Short Stature?

Answer 7

1. Undernutrition
2. Chronic Illness - JCA / IBD / Coeliac
3. Iatrogenic - Streoids
4. Psychological and Social
5. Hormonal - GHD / Hypothyroidism
6. Syndromes - Turners / Prader-Willi

Question 8

What does a Full Blood Count and Ferritin look for?

Answer 8

1. General Health
2. Coeliac Disease
3. Crohn’s Disease
4. Juvenile Chronic Arthritis

Question 9

What does a U&E’s / LFT’s / Ca / CRP look for?

Answer 9

1. General Health
2. Renal and Liver Disease
3. Disorders of Ca Metabolism

Question 10

What is Coeliac Serology and IgA looking for?

Answer 10

Coeliac Disease

Question 11

What does a IGF-1 / TFT / Prolactin / Cortisol look for?

Answer 11

Hormone Disorders

Question 12

What does a Karyotype Look for?

Answer 12

Turner’s Syndrome

Question 13

What is included in the Tanner Method of Puberty Staging?

Answer 13

1. Breast Development - 1 to 5
2. Genital Development - 1 to 5
3. Pubic Hair Development - 1 to 5
4. Axillary Hair Development - 1 to 3
5. Testis - 2ml to 20mls
6. SO - e.g. Statement as B3 PH3 / G2 PH2 6/6

Question 14

What is Early (a) / Delayed (b) Puberty for:

1. Boys?
2. Girls?

Answer 14

1. a) Early Boys - < 9 years - Rare
2. b) Late Boys - > 14 years - common,
3. a) Early Girls - <8 years
4. b) Late Girls - > 13 years - Rare

Question 15

What are the Features of Constitutional Delay of Growth and Puberty (CDGP)?

Answer 15

1. Boys Mainly
2. Family History in Dad / Brothers
3. Bone Age Delay
4. Need to Exclude Organic Disease

Question 16

What are Causes of Constitutional Delay of Growth and Puberty (CDGP)?

Answer 16

1. Gonadal Dysgenesis - Turner (45X) / Klinefelter (47XXY)
2. Chronic Disease - Crohn’s / Asthma
3. Impaired Hypothalamic-Pituitary-Gonadal (HPG) Axis:
4. a) Septo-Optic Dysplasia
5. b) Craniopharyngioma
6. c) Kallman’s Syndrome
7. Peripheral - Cryptorchidism / Testicular Irradiation

Question 17

What is the cause of Early Breast Development?

Answer 17

Hypothalamic Activation:

1. Infantile Thelarche
2. Thelarche Variant - Premature Thelarche
3. Central Precocious Puberty

Question 18

What is the cause of Early Secondary Sexual Characteristic Development?

Answer 18

Sex-Steroid Hormone Secretion:

1. Exaggerated Adrenarche
2. Precocious Pseudopuberty - Congenital Adrenal Hyperplasia

Question 19

What is the cause of Early Per-Vaginal Bleeding?

Answer 19

Premature Menarche

Question 20

What are the Features of Central Precocious Puberty?

Answer 20

1. Pubertal Development - Breasts / Testicular
2. Growth Spurt
3. Advanced Bone Age
   Note - Need to Exclude a Pituitary Lesion

Question 21

What are the Features of Precocious Pseudopuberty?

Answer 21

1. Abnormal Sex-Steroid Hormone Secretion
2. Gonadotrophin Independent - Low / Prepubertal Levels of LH and FSH
3. Clinical Picture - Secondary Sexual Characteristics
   Note - Need to Exclude Congenital Adrenal Hyperplasia

Question 22

What are the Features of Congenital Hypothyroidism?

Answer 22

1. Caused by:
2. a) Athyreosis / Hypoplastic / Ectopic
3. b) Dyshormonogenic
4. Newborn Screening
5. Start Treatment within the First 2 Weeks

Question 23

What are the Features of Acquired Hypothyroidism?

Answer 23

1. Autoimmune Thyroiditis - Most Common Cause
2. Family History of Thyroid / Autoimmune Disorders
3. Childhood Issues:
4. a) Lack of Height Gain
5. b) Pubertal Delay
6. c) Poor School Performance

Question 24

What is assessed in an Obese Child?

Answer 24

1. Weight
2. Body Mass Index (BMI) - Kg/m^2
3. Height
4. Waist Circumference
5. Skin Folds
6. History and Examination
7. Complications

Question 25

What should be looked for / at in an Obese Child?

Answer 25

1. Diet / Physical Activity 2. Family History 3. Symptoms Suggestive of: 3. a) Syndrome 3. b) Hypothalamic-Pituitary Pathology 3. c) Endocrinopathy 3. d) Diabetes 4. Drug History

Question 26

What are the Symptoms of Diabetic Ketoacidosis?

Answer 26

1. Nausea and Vomiting 2. Abdominal Pain 3. Sweet Smelling, Ketotic Breath 4. Drowsiness 5. Rapid, Deep, Sighing Respiration 6. Coma