Lecture 3: Pediatric Endocrine

Question 1

What is considered an underweight BMI for the 2-18 y/o age group?

Answer 1

BMI <5th percentile for age

Question 2

What is considered a normal weight BMI for the 2-18 y/o age group?

Answer 2

BMI ≥5th to <85th percentile for age

Question 3

What is considered an overweight BMI for the 2-18 y/o age group?

Answer 3

BMI ≥85th to <95th percentile for age

Question 4

What is considered an obese BMI for the 2-18 y/o age group?

Answer 4

BMI ≥95th percentile

Question 5

What is considered severly obese class II and class III for those 2-18 y/o?

Answer 5

• Class II = ≥120 percent of the 95th percentile or a BMI ≥35 (whichever is lower)
• Class III= ≥140 percent of the 95th percentile or a BMI ≥40 (whichever is lower)

Question 6

What is the normal growth velocity for school age children (6 y/o to puberty)?

Answer 6

≥5 cm/year (2 inches)

Question 7

When a childs weight falls off first (or more dramatically) what should you be thinking about first as an underlying cause?

Answer 7

• Nutrition
• Not enough food (emesis, no food)
• Not enough absorbed (mal-absorptive conditions)
• Higher than average caloric requirements

Question 8

When a childs height falls off first (or more dramatically) what should you be thinking about first as an underlying cause?

Answer 8

• Think endocrine
• GH deficiency
• Hypothyroidism
• Cushing’s syndrome

Question 9

When a childs head circumference falls off first (or more dramatically) what should you be thinking about first as an underlying cause?

Answer 9

• Primary failure of the brain to grow
• Severe craniosynostosis

Question 10

What is meant by “delayed bone age” in a child?

Answer 10

Bone age that is two standard deviations below the chronological age is considered delayed

Question 11

What is essential in developing the differential diagnosis and guiding the work-up for abnormal growth in a child?

Answer 11

Comprehensive history and physical

Question 12

Which growth curve charts can be used for a patient older than 24 months and how do they differ in terms of how a child is measured?

Answer 12

• If <36 months of age and using 0-36 month curve, measure length while child is supine (length)
• If older than 24 months, MAY use the 2-20 y/o chart but the height must be measured standing up (stature)

Question 13

What is “catch-up” or “catch-down” growth and when does it occur during a childs development?

Answer 13

• Occurs in first 18 months of life
• Some kids make up to a 25% downward correction on the growth curve —> often occurs as more table food is introduced
• Some kids make up to a 25% upward correction on the growth curve

Question 14

What is the definition of short stature in a child?

Answer 14

• Height 2 standard deviations below the mean height for age and sex (<3rd %tile)
• Height more than 2 standard deviations below the mid-parental height

Question 15

What is the importance of Insulin-like Growth Factor (IGF-1) and IGF binding protein 3 (IGFBP3) in the work-up of short stature?

Answer 15

Can point to GH deficiency

Question 16

With delayed puberty/short stature in females must always check what?

Answer 16

Karyotype for Turner Syndrome

Question 17

Can short stature occur in the absence of other clinical features?

Answer 17

YES

Question 18

What is the definition of precocious puberty in both boys and girls?

Answer 18

Full activation of the HPG axis before 8 years old in girls and before 9 years old in boys

Question 19

Precocious puberty should be considered a diagnosis in a girl with what characteristics?

Answer 19

• Progressive breast development
• Crossing major percentile lines upward on the linear growth chart

Question 20

Precocious puberty should be considered a diagnosis in a boys with what characteristics?

Answer 20

• Evidence of both testicular and penile enlargement
• Crossing major percentile lines upward on the linear growth chart