31: Pediatric Endo: Growth

Question 1

Healthy BMI range

Answer 1

18.5-24.9

Question 2

Normal growth velocity for school aged children (5 to puberty)**

Answer 2

5cm/year (2inches/year)

Question 3

Parameter typically affected first in children with an endocrine growth disorder

Answer 3

Height

Question 4

Delayed bone age definition

Answer 4

Bone age 2 standard deviations+ below the chronological age of pt

Question 5

When to be concerned about the trend of points on a growth curve

Answer 5

When they are crossing 2+ lines. If staying on same line, normal growth rate

Question 6

Four growth parameters on a growth charg

Answer 6

Height, weight, BMI, head circumference

Question 7

What to consider if there’s a dramatic change in: height vs weight vs head circumference

Answer 7

1. Height: endocrine
2. Weight: calories/nutrtition
3. Head circumference: brain/skull issue or hydrocephalus

Question 8

3 MC Causes of benign short stature

Answer 8

Familial, constitutional, idiopathic

Question 9

Short stature definition

Answer 9

Height 2+ standard deviations below mean height for age and sex

Question 10

Familial short stature

Answer 10

Parents are small but growth velocity is normal

Question 11

Constitutional short stature

Answer 11

Grow at low rate, puberty delayed, a “late bloomer” but end height is normal

Question 12

Idiopathic short stature

Answer 12

Short heigh but no FHx or endocrine/metabolic dx present

Question 13

Bone age vs chronological age in: familial, constitutional, and idiopathic short stature**

Answer 13

1. Familial & idiopathic: bone age + real age consistent

2. Constitutional: bone age is delayed**

Question 14

IGF-1 and IGFBP3

Answer 14

1. IGF1: major mediator of GH

2. IGFBP3: transport protein of IGF-1

Question 15

How does GH affect IGF-1?

Answer 15

GH increases IGF1 synthesis

Question 16

What cell types produce IGF-1?

Answer 16

Osteoblasts and chondrocytes

Question 17

Hormone testing in a pt with short stature

Answer 17

1. Draw IGF1, IGFBP3 -> low levels -> means there is a GH deficiency (can be drawn anytime bc arent pulsatile release like GH is)
2. Next step: GH testing with glucagon / arginine / insulin administration

Question 18

Precocious puberty definition

Answer 18

Onset of secondary sexual characteristics before 8 in girls, 9 in boys

Question 19

End height of pts with precocious puberty

Answer 19

Less than it would normally be

Question 20

Labs and imaging for suspected precocious puberty

Answer 20

1. Labs: LH, FSH, estradiol/testosterone, 17-hydroxyprogesterone
2. Imaging: bone age, MRI head, US gonads

Question 21

What causes premature Adrenarche

Answer 21

Early maturation of the zona reticularis

Question 22

When is a workup warranted for premature thelarche

Answer 22

Other signs of secondary sex maturation, accelerated growth, bone age advanced beyond 2+ SDs for age

Question 23

One of the MC preventable intellectual disabilities in the world

Answer 23

Congenital hypothyroidism

Question 24

S/s congenital hypothyroidism

Answer 24

Hoarse cry, coarse facies, lethargy, feeding problems, constipation, macroglossia, large fontanels, hypotonia, prolonged jaundice

Question 25

Acquired hypothyroidism in childhood s/s

Answer 25

Declining growth velocity, abnormal pubertal development, declining school performance, sluggishness, cold intolerance, constipation, dry skin brittle hair, facial puffiness, muscle aches

Question 26

__ is a primary determinant of normal post-natal growth, skeletal maturation, and bone & mineral metabolism**

Answer 26

T3