Growth and Endocrine Flashcards
(93 cards)
1
Q
What factor affect height
A
Genetics = most important Age Sex Race SGA Nutrition Parental height Bone age Socio-economic Psychological Chronic disease Specific growth disorder - hypothyroid / GH deficiency Puberty Drugs - steroid Syndrome
2
Q
What causes growth in infant, child puberty
A
Infant = nutrition + insulin
Quick growth
Child = GH
If defiant won’t grow
Puberty
GH
Sex hormones
Rapid growth spurt
3
Q
How do you assess growth development
A
Height / length Weight Growth chart Mid Parental Height Growth velocity Bone Age Pubertal Assessment Head circumference
4
Q
When do you refer
A
Extreme shortchanged or tall Below target heigh Abnormal velocity of height Hx chronic disease Obvious dysmorphia Early / late puberty
5
Q
What are causes of short stature (2 SD below for age and sex)
A
Familial Constituional delay SGA / IUGR - give GH Undernutrition Chronic disease - IBD / coeliac Iatrogenic - steroid Psychological Endocrine Syndromes
6
Q
What endocrine cause short stature
A
GH deficiency
Hypothyroid
Glucocorticoid excess
7
Q
What syndromes cause short stature
A
Turner Down's Prader-Willi Noonan Achondroplasia
8
Q
How do you investigate short stature
A
FBC + ferritin U+E, LFT, Ca, CRP Coeliac serology and IgA IGF-1, TFT, prolactin, cortisol, sex hormones Karyotype for syndrome MRI pituitary
9
Q
What do you do if IGF-1 is low
A
GH stimulation test
If negative = GH deficiency
10
Q
What is achondroplasia
A
AD Trident hand Lumbar lordosis Midface hypoplasia Macrocephaly Short fingers
11
Q
How do you treat SGA
A
GH
12
Q
When do you review bt GP
A
Growth <2nd gentile
13
Q
WHen do you review by paediatrics routinely
A
If <0.4
14
Q
How do you calculate weight
A
2 (Age + 4)
15
Q
How much taller do boys grow than girls
A
12.5cm
16
Q
How do you calculate mid parental height / predicted height
A
Boy = (Mum + 12.5/2) + Dad Girl = (Dad - 12.5/2) + mum
17
Q
What causes failure to thrive
A
Inadequate nutritional intake Decreased intake / difficulty feeding Increased demand Excess loss / malabsorption Inability to process
18
Q
What is your weight, length and OFC at birth
A
3.5kg
50cm
35cm OFC
19
Q
At 4 months
A
6.6kg
60cm
20
Q
12 months
A
10kg
75cm
45cm OFC
21
Q
3 years
A
15kg
95cm
22
Q
Causes of FTT
A
Energy < demand
Inadequate intake
- Maternal if breast - poor lactation
- Incorrect feed
- Iron deficiency anaemia
- Neglect
Poor feeding
- Premature
- Neuromuscular causing poor suck
- Cleft lip or palate
Excess loss / malabsorption
- Pyloric stenosis
- Reflux
- Gastroenteritis
- Coeliac
Inability to Process
- Inborn error of metabolism
- Type 1 DM
Increased requirement
- Chronic infection - HIV
- Chronic disease - congenital heart or lung
- Hyperthyroid
- Malignancy
23
Q
What causes malabsorption
A
Allergy Coeliac CMPI Short bowel IBD CF Chronic diarrhoea Gastroenteritis
24
Q
How does FTT present
A
Growing too slow
Poor weight gain
Delayed mile stone
Faltering of centiles on growth chart
25
What do you look for in history and exam
```
Pregnancy
Birth
Diet
FH
Social history
Dysmorphism
Development
Posture / neuromuscular
Plot height, weight and BMI on growth chart
Calculate mid parental - if two below suggests issue
```
26
How do you investigate
```
FOR ALL
Trial hospital feed
Observation of feeding
Parent / child interaction
Urine dip for UTI
Coeliac screen
Further investigations depending on suspected cause
```
27
If good intake and weight gain
Non-organic
28
If good intake and no weight gain
Organic
29
If poor intake
Organic or feeding disorder
30
What are non organic reversible causes
```
Poverty
Poor support
Neglect
Drugs or depression in family
Poor feeding
Emotional deprivation
Anorexia / bulimia
```
31
Average age of puberty in boys
11.5
Early = <9
Late = >14
32
Sequence in boys
Testicular growth
Penile growth
Late growth age 14
Facial hair and voice break at the end
33
Average age of puberty in girls
11
Early <8
Late >13
34
Sequence in girls
Breast bud
Pubic growth
Early growth
Menarche at end
35
What causes delayed puberty
Hypogonadotrophic hypogonadism (low FSH / LH leading to low sex hormones)
- Damage to hypothalamus / AP - surgery / RT / tumour
- GH deficiency
- Hypothyroid
- Hyperprolactin
- Serious chronic disease
- Excessive exercise or diet
- Constitutional delay
- Kallman - anosmia
Hypergonadotrophic hypogonadism (high FSH / LH trying to stimulate)
- Damage to gonads - RT / cancer / torsion / mumps / autoimmune
- Cryptochidism
- Klienfelter - XXY
- Turner - XO
- Androgen insensitivity
```
Other
Prader- WIlli
Noonan
PCOS
Imperforate hymen
```
36
What causes impaired HPG
Kallman
| Craniopharyngioma
37
What causes constitutional delay
```
Often FH
Due to bone age delay
Short stature but will reach normal adult height
Puberty is delayed
Affects boys
Exclude organic and reassure
```
38
What causes central precocious puberty (early puberty)
Premature activation of HPG
Gonadotrophin dependent
FSH and LH raised
All areas of puberty early
39
Do you worry in female
No
Idiopathic
Measure FSH level
Should follow normal sequences
40
What do you think if boys and what do you do / what does it cause
Brain tumour - Craniopharyngioma / NF
Tubero sclerosis
Hypothyriod
Do MRI
Causes bilateral enlarged testicles
41
What is thelarche and adrenarche
First breath
| First pubic hair
42
What is pseudo puberty
```
Gonadotrophin independent
FSH and LH low
Excess sex hormones produced from sex organs
Develop sexual characteristics <8 or <9
Advanced bone age
```
43
If bilateral small testis what does it suggest
Adrenal tumour
Adrenal hyperplasia
Steroid
44
If unilateral enlarged
Gonadal tumour
| Lydia as produce androgen
45
What staging is used for puberty
```
Tanner staging
Axillary hair
Pubic hair
Breast
Genitals
Testicular volume
```
46
What measures testicular volume
Prader Orichidometer
47
What is important to notice
Breast bud - B2
| Enlargement testicles - 3-4ml
48
What tests if delayed puberty
History - health, development, FH, diet
Examination - height, weight, puberty
Initial
- FBC, ferritin for anaemia, U+E for CKD and coeliac screen
Hormones
- FSH = 1st line (will differentiate between central and peripheral)
Pelvic USS to assess ovary / confirm normal anatomy
Other
- TFT, IGF-1, serum prolactin
- Genetic testing / Karyotype
- X-ray for bone age in constitutional
- MRI
49
What must you exclude if ambiguous genitalia
Congenital adrenal hyperplasia
| - 21 hydroxyls = most common
50
What do you give for central puberty
GnRH agonist
51
What should TV be at peak height velocity
10ml
52
What is normal
15-25ml
53
What are normal changes in puberty
Gynaecomastia
Asymmetrical breast
Enlargement of thyroid
54
If PV bleeding with no sexual characteristics
INVESTIGATE
Trauma
Candida
Vulvovagnitis
55
When is it rare
Pre-pubertal
56
What is Klienfelter
47XXY
Primary hypertrophic hypogonadism
High LH / FSH
Low testosterone
57
How does it present
```
Appear normal until puberty
Tall height
Weak muscles
Lack 2 sexual characteristics
Small testicles
Reduced libido
```
Infertile
Gynaecomastia
58
How do you Dx
Chromosome analysis
59
How do you treat
Testosterone injections
Advanced IVF
Breast reduction
MDT = SALT, OT, physio
60
What can cause it
Testosterone secreting tumour
61
What is Kallman
XR
Hypogonadotrophic hypogonadism
LH low
Low testosterone
62
What is associated
Cleft lip
| Visual / hearing
63
What are the symptoms
Cryptorchidism
Anosmia
Normal height
64
What is androgen insensitivity
XR
Genotype shows 46XY
Female phenotype
65
How does it present
Breast development
Primary amenorrhoea
Undescended testis
Resistant to testosterone
66
How do you Dx
Chromosomal analysis
LH high
Testosterone normal
67
How do you Rx
Counselling
Oestrogen therapy
Remove undescended testis
68
What causes obesity
```
Intake > activity = most common
Insulin
Steroid
Sodium valproate
Prader Willi
Trisomy 21
Hypothyroid
GH deficiency
Cushing
Increased androgen
Insulin resistance
Hypothalamic damage = no control
```
69
What is abnormal
Obese and short
| Do BMI adjusted for age and gender
70
What can obesity cause
```
SUFE / MSK
Poor self esteem
Sleep apnoea
Snoring
Benign intracranial hypertension
Type 2 DM
IHD
Malignancy
PCOS
Pancreatitis
Gall stone
Liver disease
VTE
```
71
Ddx snoring
```
Obesity
Sleep apnoea
Nasal polyp
Deviated nasal septum
Tonsiliits
Down's as reduced muscle tongue and large tongue
Hypothyroid
```
72
How do you investigate
```
Weight, height, BMI
Food diary
Drug Hx
Genotype
TFT / Cortisol / IGF-1
```
73
What causes hypothyroid
Autoimmune thyroiditis 'Hashimoto' = most common
RT e.g. after leukaemia
Iodine deficiency = most common developing world
```
Congenital
Atheytosis - absence
Hypoplasitc - underdevelopment
Ectopic
Dyshormogenic - doesn't produce
```
74
What are the symptoms
Congenital
- Prolonged jaundice
- Hypothermia
- Hypotonia
- Poor feed
- Constipation
- Increased sleeping
- Slow growth / FTT
Acquired
- Poor growth
- Weight gain
- Constipation
- Coarse voice
- Dry skin
- Macroglossia
- Puffy face
- Puberty delay
75
How do you Dx
Guthrie heal prick for congenital
| TSH, thyroid USS, and thyroid Ab
76
How do you Rx and what are complications if don't
Within 2 weeks of screen
Levothyroxine
Cretinism if don't - impaired mental / stuned growth due to permissive on GH and retain infantile features
77
What are features of adrenal insufficiency in babies
```
Lethargy
Vomiting
Poor feed
Hypoglycaemia
Jaundice
FTT
```
78
What are features in children
```
Poor weight gain or loss
N+V
Anorexia
Abdo pain
Muscle weakness and crmaps
Developmental delay
Bronze pigmentation
```
79
How do you investigate suspected
U+E - hyponatraemia and hyperkalaemia
Blood glucose - low
Specific tests for adrenal causes
80
How are kids managed
```
Growth and development
BP
U+E
Glucose
Bone profile
VIt D
```
81
How is congenital adrenal hyperplasia inherited
AR
82
What enzyme is deficient
21-hydroxylase
83
What does it lead too
Underproduction of cortisol and aldosterone as require enzyme to produce from progesteron
Overproduction of androgens - testosterone as excess progesterone converted as don't require
84
How do females with severe congenital adrenal hyperplasia present
Ambigious genitalia
Enlarged clitoris
Virilisation
SKIN HYPERPIGMENTATION due to excess ACTH
Salt wasting crisis as cortisol / aldosterone not formed
Hyponatraema, hyperkalaemia and hypoglycaemia
- Leads to poor feed, vomtiing, dehydration and arrhythmia
85
How do mild cases present in female
```
Tall for age
Absent period
Facial hair
Deep voice
Early period
```
86
How do mild cases present in male
```
Tall for age
Deep voice
Large penis
Bilateral small testicles
Early puberty
```
87
What causes GH deficiency
Genetic
| Acquired - infection, trauma, surgery
88
What does it occur with
Can be isolated
| Or occur with other pituitary hormone deficiency
89
How does GH deficiency present in neonates
Micropenis
Hypoglycaemia
Severe jaundice
90
How do older children present
Poor growth
Short stature
Delayed puberty
91
How do you investigate
GH stimulation test
MRI brain
Genetic test - Turner / Prader-Willi
X-ray for bone age to predict final height
92
What is GH stimulation
Give hormones which usually stimulate
- Glucagon
- Insulin
Lack of response
93
How do you Rx
Daily SC GH
| Close monitoring of height and development
