Endocrinology Flashcards
(23 cards)
important physical measurement in peds
short stature
first question with low growth measurement
“how was this done” / re-check
normal growth rate by year
- birth - 1 year: 10in / 25cm
- 1 -4 years: 4in / 10cm per year
- school age - 12: 2in / 5cm per year
causes of short stature
- genetics
- familial (mid-parental height helpful)
- disorders (Downs, Turner)
- constitutional growth delay
- bone age vs. actual age
- malnutrition
- endocrine causes
evaluation of child w/ short stature
- PE
- wheezing, masses, etc
- CBC, ESR
- chronic dz
- electrolytes, LFTs, BUN, Cr, UA
- metabolic and renal fx
- stools to eval. fat metabolism
- celiac dz screening
- thyroid function (hypo- growth cessation)
- growth hormone testing
- genetic testing
physical sign indicating need for GH testing
under-tall and overweight
- insuline-like growth factor (IGF-1) and IGF binding protein 3 (IGFBP-3) tested
- idiopathic causes MC
folllow-up if IGF and IGFBP-3 levels low
- can be low nutrition and disease state
- MRI of brain to r/o brian tumor (craniopharyngioma)
- bone age to check maturity with chronological age
- hospitalize for GH stimulation test - induced hypoglycemia fails to stimulate GH (+ test)
Tx of GH deficiency
recombinant HGH
- single dose SQ daily
- track height q3m
- follow bone age - stop when epiphyses fused (prevent acromegaly)
production of adrenal hormones
responsible for pubertal development
(occurs before pubertal changes seen)
adrenarche
pituitary stimulation causing adrenarche
dev. of pubic & axillary hair, oiliness, acne, odor
(produced by something other than gonads)
pubarche
secretion of sex hormones secondary to maturation of hypothelamic-pituitary-gonadal axis
(testosterone/estrogen production -
pubertal growth spurt)
gonadarche
normal delayed puberty
constitutional growth delay
- often family hx of delayed puberty
- bone age delayed: puberty begins at bone age 12-13
- offer reassurance
abnormal delayed puberty d/t
deficiency of pituitary hormones for gonadarche
(FSH/LH)
hypo-gonadotropic hypogonadism
(causes: hypopituitarism, CNS tumor, anorexia nevosa, athletic hypopituitarism, hypothyroidism)
abnormal delayed puberty d/t
ovarian/testicular failure
(gonads not responding to FSH/LH)
hyper-gonadotropic hypogonadism
(causes: Turner (XO) in females, Kleinfelter (XXY) in males)
ages of precocious pubery
secondary sexual characteristics
before age 9 in boys, age 8 in girls
2 types of precocious puberty
- central
- premature maturation of hypothalamic-pituitary-gonadal axis (pituitary)
- peripheral
- premature start of ovaries/testicles
what tested for precoscious puberty
adrenal androgens - 17-OH serum progesterone
different but normal - what do you do
- premature thelarche
- premature pubarche
- gynecomastia
- prem. thelarche- isolated breast development in girls ages 6mo - 3y
- no testing or treatment
- prem. thelarche- isolated development of pubic hair
- r/o adrenal hyperplasia
- gynecomastia- normal in pubertal boys
- monitor for Kleinfelter or high estrogen
cause of genital development
male/female from same embryonic tissue
testosterone virilizes embryo at weeks 9-13
no testosterone- female genetalia develop
ambiguous genitalia - 2 types
- XX psuedohermaphrodite
- ovaries w/ virilized genitalia
- XY psueodhermaphrodite
- testes w/ undervirilized genitalia
must screen for this deadly dz associated
with ambiguous genitalia
adrenal insufficiency
critically ill in first few days of life - can die from acidosis and hypotensive shock
2 adrenal gland diseases
- Addison’s
- autoimmune destruction of adrenal gland
- lifelong replacement of glucocorticoids
- Cushing’s
- too much cortisol
- central obesity, growth failure, buffalo hump, striae
female athlete triad
- amenorrhea
- eating disorder
- low bone mineral density
