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paediatrics > Growth and Endocrine > Flashcards

Growth and Endocrine Flashcards

1
Q

history and examination for establishing growth and development?

A

birth weight and gestation

PMH

family history/social history/schooling

systematic enquiry

dysmorphic features

systemic examination

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2
Q

growth assessment tools

A

height/length/weight

growth charts and plotting

MPH (mid parental height) and target centiles

growth velocity

bone age

pubertal assessment

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3
Q

tanner method of pubertal staging

A 
Breast development (B): 1 to 5
Genital development (G): 1 to 5
Pubic hair (PH): 1 to 5
Axillary hair (AH): 1 to 3
Testicular volume (T): 2ml to 20ml
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4
Q

hormones involved in puberty

A

growth hormones

sex hormones

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5
Q

important stages in puberty?

A

breast budding: Tanner stage B2

testicular enlargement: Tanner stage G2 / T4ml)

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6
Q

growth disorders: indications for referral

A

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

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7
Q

common causes of short stature

A

familial
constitutional
SGA/IUGR (Small for gestational age)

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8
Q

What are the pathological causes of short stature?

A
  • Undernutrition
  • Chronic illness (JCA, IBD, Coeliac)
  • Iatrogenic (steroids)
  • Psychological and social
  • Hormonal (GHD, hypothyroidism)
  • Syndromes (Turner, Prader Will)
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9
Q

What is the most important pubertal stage in a girl?

A

B2

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10
Q

What is the most important pubertal stage in a boy?

A

T3-4ml

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11
Q

What is considered early puberty in a boy?

A

<9 years (rare)

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12
Q

What is considered late puberty in a boy?

A

> 14 (common, especially CDGP)

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13
Q

What is considered early puberty in a girl?

A

<8 years

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14
Q

What is considered late puberty in a girl?

A

> 13 years (rare)

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15
Q

Who does constitutional delay of growth usually affect?

A

Boys particularly those with a family history (dad and brothers. though may difficult to obtain)

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16
Q

Why does constitutional delay of growth occur?

A

There is bone age delay

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17
Q

Give examples of causes of delated puberty.

A
  • Gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
  • Chronic disease (Crohn’s, asthma)
  • Impaired HPG axis (septo-optic dysplasia, craniopharyngioma, Kallman’s syndrome)
  • Peripheral (cryptorchidism, testicular irradiation)
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18
Q

What can cause early breast development?

A
  • Infantile thelarche
  • Thelarche variant (premature thelarche)
  • True central precocious puberty
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19
Q

What can cause early secondary sexual characteristics?

A
  • Exaggerated adrenarche

- Precocious pseudopuberty

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20
Q

What can cause early PV bleeding?

A

Premature menarche

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21
Q

What does central precocious puberty present with?

A
  • Breast development in girls
  • Testicular enlargement in boys
  • Growth spurt
  • Advanced bone age
22
Q

What causes central precocious puberty?

A
  • Usually idiopathic in girls but pituitary imaging should be done
  • Underlying cause i.e. brain tumour
23
Q

How is central precocious puberty treated?

A

GmRH agonist

24
Q

What is precocious pseudo puberty?

A

Gonadotrophin independent (low /prepubertal levels of LH and FSH) process in which there is abnormal sex steroid secretion leading to early virilisation and secondary sexual characteristics

25
Q

Give examples of endocrine problems that children may present with not related to puberty.

A
  • The new-born with ambiguous genitalia
  • Congenital hypothyroidism
  • Acquired hypothyroidism
  • Thyroid deficiency
  • Obesity
26
Q

How should you manage the new-born with ambiguous genitalia?

A
  • Do not guess the sex of the baby
  • Multidisciplinary approach (paediatrics, endocrine, surgery, neonatologist, geneticist, psychologist)
  • Exam: gonads?/internal organs
  • Karyotype
  • Exclude congenital adrenal hyperplasia (Risk of adrenal crisis in first 2 weeks of life’)
27
Q

How many births are affected by congenital hypothyroidism?

A

1 in 4000

28
Q

What causes congenital hypothyroidism?

A
  • Athyreosis/hypoplastic/ectopic

- Dyshormonogenic

29
Q

When should treatment for congenital hypothyroidism be started?

A

-New born screening followed by commencement of treatment within the first 2 weeks

30
Q

What is the most common cause of acquired hypothyroidism?

A

Hashimoto’s thyroiditis

31
Q

What issues does acquired hypothyroidism present with in childhood?

A
  • Lack of height gain
  • pubertal delay (or precocity)
  • Poor school performance (but work steadily)
32
Q

What is abnormal when it comes to obesity?

A

To be short and obese is abnormal

33
Q

How many children are overweight or obese?

A

Nearly a third (31%) of children aged 2-15 are overweight or obese

34
Q

Define overweight

A
  • BMI 25-29.9

- BMI>85th centile or SD >1.04

35
Q

Define obese

A
  • BMI >30

- BMI>97.5th centile or SD >2

36
Q

How should an individual be assessed for obesity?

A
  • Weight
  • Body mass index (BMI) (kg/m^2)
  • Height
  • Waist circumference
  • Skin folds
  • History and examination
37
Q

What is important in gaining in the history when assessing someone’s obesity?

A
  • Diet
  • Physical activity levels
  • Family history
  • Symptoms suggestive of a syndrome, hypothalamic-pituitary pathology, endocrinopathy or diabetes.
38
Q

What is important when examining someone when assessing their obesity?

A
  • Dark velvet rash indicative of diabetes
  • Goitre
  • BP
  • Imaging of pituitary
39
Q

Give examples of obesity complications.

A
  • Metabolic syndrome
  • Fatty liver disease (non-alcoholic steatohepatitis)
  • Gallstones
  • Reproductive dysfunction (e.g. PCOS)
  • Nutritional deficiencies
  • Thromboembolic disease
  • Pancreatitis
  • Central hypoventilation
  • Obstructive sleep apnoea
  • Gastroesophageal reflux disease
  • Orthopaedic problems (slipped capital femoral epiphysis, tibia vara)
  • Stress incontinence
  • Injuries
  • Psychological
  • Left ventricular hypertrophy
  • Atherosclerotic cardiovascular disease
  • Right sided heart failure
40
Q

What can obesity be caused by?

A
  • Simple obesity
  • Drugs
  • Syndromes
  • Endocrine disorders
  • Hypothalamic damage
41
Q

What drugs can cause obesity?

A
  • Insulin
  • Steroids
  • Antithyroid drugs
  • Sodium valproate
42
Q

What syndromes can cause obesity?

A
  • Prader Willi syndrome
  • Laurence-Moon Biedl syndrome
  • Pseudohypoparathyroidism type I
  • Down’s syndrome
43
Q

What endocrine disorders can cause obesity?

A
  • Hypothyroidism
  • Growth hormone deficiency
  • Glucocorticoid excess
  • Hypothalamic lesion (tumour/trauma/infection)
  • Androgen excess
  • Insulinoma
  • Insulin resistance syndromes
  • Leptin deficiency
44
Q

What is the treatment for obesity?

A
  • Diet
  • Exercise
  • Psychological input
  • Rarely drugs
  • Surgery
45
Q

What is the most common cause of obesity?

A

Simple obesity

  • Increased intake
  • Decreased activity
46
Q

How is an early diagnosis of T1DM made in children?

A

THINK symptoms

  • Thirsty
  • Thinner
  • Tired
  • Toilet more often
47
Q

What additional symptoms are there in children under 5 with T1DM?

A
  • Heavier than usual nappies
  • Blurred vision
  • Candidiasis (oral, vulval)
  • Constipation
  • Recurring skin infections
  • Irritability, behaviour change
48
Q

What is a red flag symptom for T1DM in a child who is toilet trained?

A

A return to bedwetting or day=wetting in a previously dry child is a red flag symptom for diabetes

49
Q

What should you do if a child presents with suspected T1DM?

A

Test immediately

  • Finger prick capillary glucose test. If result >11mmol/l then diabetes, if <11mmol/l other cause
  • DO NOT request a returned urine sample
  • DO NOT arrange a fasting blood glucose test
  • DO NOT arrange an oral glucose tolerance test
  • DO NOT wait for lab results (urine or blood)
  • DK
50
Q

What should you if a child with suspected T1DM finger prick test is over 11mmol/l?

A

Telephone urgently

  • Contact your local specialist team for a same day review
  • DKA can occur very quickly in children
  • If in any doubt about a diagnosis of type I diabetes call for advice
  • Don’t delay the diagnosis
51
Q

What are the symptoms of DKA?

A
  • Nausea and vomiting
  • Abdominal pain
  • Sweet smelling ‘ketotic’ breath
  • Drowsiness
  • Rapid, deep ‘sighing’ respiration
  • Coma

paediatrics (37 decks)

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