Endocrine problems in childhood Flashcards Preview

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Flashcards in Endocrine problems in childhood Deck (13):
1

Explain hypothyroidism in newborns including the identification ond managment

• 1 in 4000 births
• Causes
- Athethyrosis/ hypoplastic/ ectopic
- Dyshormonogenic
• Newborn screening
• Start treatment within the first 2 weeks (prevents developmental disorders later in life)

2

Discuss the clinical features hypopituitarism in adult and children

• Most common cause: autoimmune (Hashimoto's) thyroiditis
• Family history of thyroid/ autoimmune disorders
• Childhood issues
- Lack of height gain
- Pubertal delay (or precocity)
- Poor school performance (but work steadily)

3

With regards to height what are the indications for referral?

- Extreme short or tall stature (off centiles)
- Height below target height
- Abnormal height velocity (crossing centiles)
- History of chronic disease
- Obvious dysmorphic syndrome
- Early/ late puberty

4

What are the pathological causes of short stature?

- Undernutrition
- Chronic illness (JCA, IBD, coeliac disease)
- Iatrogenic (steroids)
- Psychological and social
○ children don't grow in their home environment but as soon as they go into care they grow very quickly
- Hormonal
○ Growth hormone deficiency
○ Thyroid deficiency: when presenting with hypothyroidism they are short and heavy but once they are treated the height goes up and the weight goes down
- Syndromes
○ Turner's syndrome
○ Prader-Willi syndrome
○ Noonan's syndrome
○ Achondroplasia

5

What are the effects of obesity on growth?

• Obesity makes children taller
• It is abnormal if you have an obese and short child (that is the point you should be concerned)
• Obese individuals go through puberty earlier and so the normal individual is about the same height once they have stopped growing

6

What are the complications of obesity?

- Metabolic syndrome
- Fatty liver disease
- Gallstones
- Reproductive dysfunction
- Notational deficiencies
- Thromboembolic disease
- Pancreatitis
- Central hypoventilation
- Obstructive sleep apnoea
- Gastroesophageal reflux disease
- Orthopaedic problems
- Stress incontinence
- Injuries
- Phycological
- Left ventricular hypertrophy
- Atherosclerotic cardiovascular disease
- Right-sided heart failure

7

What are the causes of obesity?

- Simple obesity
- Drugs
○ Insulin
○ Steroids
○ Antithyroid drugs
○ Sodium valproate
- Syndromes
○ Prader Willi syndrome
○ Laurence- Moon-Biedl syndrome
○ Pseudohypoparathyroidism type 1
○ Down's syndrome
- Endocrine disorders
○ Hypothyroidism
○ Growth hormone deficiency
○ Glucocorticoid excess
○ Hypothalamic lesion (trauma/ tumour/ infection)
○ Androgen excess
○ Insulinoma
○ Insulin resistance syndromes
○ Leptin deficiency
- Hypothalamic damage

8

What is the treatment for obesity?

- Diet
- Exercise
- Physiological input
- Drugs???
○ There are drugs for obesity but not really for children

9

What are the ages of early and delayed puberty in girls and boys?

- Girls
○ Early < 8 years
○ Delayed > 13 (rare)
- Boys
○ Early < 9 years (rare)
○ Delayed > 14 (common, especially CDGP)

10

Explain constitutional delay of growth and puberty (CDGP)

- Mainly boys
- Family history
- Bone age delay
- Need to exclude organic disease

11

What are the causes (other than CDGP) of delayed puberty?

- Gonadal dysgenesis
○ Turner 45X
○ Klinefelter 57XXY
- Chronic disease
○ Crohn's
○ Asthma
- Impaired HPG axis
○ Septo-optic dysplasia
○ Craniopharyngioma
○ Kallman's syndrome
- Peripheral
○ Cryptorchidism
○ Testicular irradiation

12

Explain central precocious puberty

- Pubertal development
- Breast development in girls
- Testicular enlargement in boys
• Growth spurt
• Advanced bone age
• Girls
- Usually idiopathic
- Pituitary imaging
• Boys
- Look for underlying cause i.e. brain tumour
• Treatment: GnRH agonist

13

Explain precocious pseudopuberty

• Gonadotropin independent (low/ prepubertal levels of LH and FSH)
• Abnormal sex steroid hormone secretion
• Virilasing or feminasing
• Clinical picture: Secondary sexual characteristics