Ch 11 - Growth and Puberty Flashcards Preview

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Flashcards in Ch 11 - Growth and Puberty Deck (25)
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Fraser guidelines for contraception (5)

The young person must undertand the advice The young person cannot be persuaded to inform their parents (or let the professional contact them) The young person is likely to continue having sex +/- contraception Unless the young person receives contraception their physical +/- mental health is likely to suffer The young person's best interests require them to receive contraceptive advice or treatment with or without parental consent


Sex and child protection: regarding children younger than 13 (1) & children between 13 & 16

So if child


Sequence of puberty in females (3)

Breast development (8.5-12.5 yrs) > pubic hair + height spurt immidiately after > menarche 2.5 yrs after start of puberty


Breast developement stages (5)

B1 = prepubertal B2 = bud B3 = juvenile smooth contour B4 = areola + papilla project over breast B5 = adult


Pubic hair developement - applies to both males and females (5)

1 = none 2 = sparse, pigmented, long striaght 3 = dark, coarser, curlier 4 = filling out 5 = adult in quantity, spread to medial thigh in males


Males pubertal sequence: (3)

Testicular enlargement - to > 4ml (9-13yrs) > Pubic hair (10-14yrs) > Height spurt - testicular vol > 12-15 ml


Male genitals development (5)

1 >2 lengthening of penis > 3 increased growth in length/ circumfrence > 4 development of glans penis & darkening of scrotum > 5 adult


Assessment of male (1), female (1), skeletal maturation (1)

Male - orchidometre Female - USS pelvis - uterine size & endometrial thickness Skeletal maturation - bone age (hand & wrist xray )


Short stature definiton (1)

Height below 2nd centile/ 0.4th centile


Causes of short stature (categories - 5)

Familial Constitutional - also dieting/exercise > legs long compared to back (can use androgens to induce puberty) Chronic illness - e.g. Coeliac's Endocrine - Hypothyroidism, Cushing's, GH def Psychosocial deprivation - neglect/abuse - catch up in nurturing environment IUGR + extreme prematurity - 1/3 remain short > GH treatment Genetic - Noonan's, Turners, Down's,


3 causes of extreme short stature

Laron syndrome - GH resistance Primordial dwarfism idiopathic


3 causes of disproportionate short stature

Achondroplasia (autosomal dom, mutation in fibroblast growth factor receptor) Scoliosis storage disorders


Ixs for short stature (6)

Clinical - mid parental height first (avg +/- 7), height, weight, growth chats, HEIGHT VELOCITY - 2 measurements a year apart - below 25th centile persistently is abnormal bloods - FBC (anaemia), U & C (renal failure), Ca/PO/ALP (bone), TFTs, Coeliac screen (TTG), CRP (Crohn), GH provocation - GH def Bone age, MRI for intracranial tumour


Caused of Tall stature (6)

Familial - most common Obesity - puberty is advanced - however because it occurs at earlier age final height centile is lower endocrine - gigantism (GH), hyperthyroid, preocious puberty, CAH Syndromes - Long legged tall stature: Marfan, hymocystinuria, Klinefelter (47 XXY). Proportionate tall stature at birth - maternal DM, primary hyperinsulinism, Beckwith syndrome, Sotos syndrome - large head, LDs,


Management of tall stature

Rarely done But if it is pre/ early pubertal may gave oestrogens/androgens to fuse epiphysis - rarely conducted


Microcephaly: definition, causes (4)

Head circumfrence below 2nd centile C - congenital infection (CMV, rubella, toxo), insult to developing brain (hypoxia, hypoglycaemia), familial,


Macrocephaly: definion, causes (4)

Head circ above 98th centile C - Tall stature, familial, hydrocephalus, chronic subdural haematoma, tumour, NF, Sotos, Fragile X


Craniosynostosis: definition

Premature fusion of skull sutures (shouldn't fuse till late childhood) types: Sagittal craniosynostosis - long narrow, coronal (asymmetrical), Lambdoid - flattened


Precocious puberty: define (1), significant cause in males (1), assessment of testicles (3)



Precocious puberty in females: causes (3), McCune-Albright syndrome triad (3)

C - idiotpathic, familial, organic cause - e.g. CAH, Cushing, androgen secreting tumours McCune-Albright - precocious puberty + cafe au lait spots + polyostotic fibrious dysplasia


Pseudoprecocious puberty: define, causes (2)

Abnormal course of puberty e.g. growth spurt without breast budding, usually GONADOTROPHIN-INDEPENDENT - extracranial e.g. Cushing, CAH, adrenal tumours


Premature breast developement (thelarche) define, Ix if any, management

Breast development in females between 6 months -2 yrs (absence of other pubertal features) No Ix required, self limiting and non-progressive so reassure


Pre mature pubarche (adrenarche): define, cause, Ix (3), Management (1)

D - pubic hair development


Delayed puberty: define, causes (4)

>12/13 in F/M Causes: familial, constitutional, Hypogonadotropic hypogonadism: systemic disease e.g. CF/ Crohn/ starvation. Hypothalamo-pituitary e.g. IC tumours, panhypopituatrism, isolated def Acquired hypothyroidism Hypergronadotropic hypogonadism: chromosomal e.g. Turner, Klinefelter. Steroid, acquired gonadal damage e.g. chemo/trauma


Congenital adrenal hyperplasia

F - clitoral hypertrophy (in F), enlarged penis + scrotal pigmentation, tall stature, muscular build, adult body odour, pubic hair, acne Ix - Serum 17a hydroxyprogesterone + hyponatraemia + hyperkalaemia + metabolic acidosis + hypoglycaemia; urine pregnanetriol