Endocrinology and Diabetes Flashcards
(17 cards)
What is normal infantile, childhood and pubertal growth rate?
Infantile - 10-20cm/yr
Childhood - 5-7cm/yr
Puberty - 10-15cm/yr
What are assessment tools for growth disorder?
Height/length/weight Growth charts and plotting MPH and target centiles Growth velocity Bone age Pubertal assessment
What are indications for referral in growth disoders?
Extreme short or tall stature (off centiles)
Heigh below target height
Abnormal height velocity (crossing centiles)
Hx chronic disease
Obvious dysmorphic symptoms
Early/late puberty
What are common causes of short stature?
Familial
Constitutional
SGA/IUGR
What are pathological causes of short stature?
Undernutrition Chronic illness (JCA, IBD, coeliac) Iatrogenic (steroids) Psychological and social Hormonal (GHD, hypothyroidism) Syndromes (turner, P-W)
What investigations would you carry out for growth disorder?
FBC and ferritin; general health, coeliac, JCA
Us&Es, LFT, Ca, CRP; general health, renal and liver disease, disorders of Ca mechanism
Coeliac serology and IgA
IGF-1, TFT, prolactin, cortisol; hormonal disorders
Karyotype; Turner’s syndrome
Describe growth hormone stimulation test
Arginine test; should stimulate GH release
Insulin tolerance test
What may the MRI of pituitary of a child with growth hormone deficiency look like?
Ectopic posterior pituitary gland
Small anterior pituitary gland
Describe the Tanner method of pubertal staging
B 1-5 (breast development
G 1-5 (genital development)
PH 1-5 (pubic hair)
AH 1-5 (axillary hair)
T 2ml to 20ml
What do you use to measure testicular maturation?
orchidometer
Early and delayed puberty?
Girls; early <8 , delayed >13 (rare)
Boys; early <9 (rare), delayed >14 (common)
Describe constitutional delay of growth and puberty?
Boys mainly
FHx in dad or brothers
Bone age delay
Need to exclude organic disease
Describe central precocious puberty
Pubertal development - breast in girls - testicular enlargement in boys Growth spurt Advanced bone age
Need to excuse pituitary lesion
Describe precocious pseudopuberty
Abnormal sex steroid hormone production
Gonadotrophin independent
Clinical picture; secondary sexual characteristics
Need to exclude Congenital Adrenal Hyperplasia
Management of ambiguous genitalia
Do not guess sex of baby
Obtain karyotype
Exam; gonads? internal organs?
Exclude; congenital adrenal hyperplasia - risk adrenal crisis in first two weeks of life
Describe congenital hypothyroidism
Causes; athyreosis, hypoplastic, ectopic, dyshormogenic
Newborn screening
Start treatment within first 2 weeks
Describe acquired hypothyroidism
Most common cause; autoimmune (hashimotos) thyroiditis
FHx thyroid/autoimmune disorders
Childhood issues;
- lack height gain
- pubertal delay (or precocity)
- poor school performance
