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Paeds > Growth and Endocrine > Flashcards

Growth and Endocrine Flashcards

1
Q

Factors influencing height

A 
Age
Sex
Race
Nutrition 
Parental heights
Puberty 
Skeletal maturity (bone age)
General health 
chronic disease
specific growth disorders
socio-economic status
emotional well being
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2
Q

Measurement techniques

A

Sitting height

Head circumference

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3
Q

Who Is head circumference routine in?

A

< 2 y /o

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4
Q

Where do you put the tape in head circumference?

A

Tape around forehead and occipital prominence (maximal circumference)

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5
Q

Assessment tools of growth

A 
Height 
Length 
weight 
growth charts and plotting
MPH and target centiles
Growth velocity 
Bone age 
Pubertal assessment
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6
Q

Indications for referral in growth disorders

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

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8
Q

Pathological causes of short stature

A 
Undernutrition 
Chronic illness (JCA, IBD, coeliac) 
Iatrogenic (steroids)
Psychological and social 
Hormonal (GHD, hypothyroidism)
Syndromes (turner, P-W)
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9
Q

What test would you do to look for turners syndrome?

A

Karyotype

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10
Q

What tests would you do to look out for hormonal disorders?

A

IGF-1
TFT
prolactin
Cortisol (gonadotrophins and sex hormones)

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11
Q

What tests do FBC and ferritin look at?

A

General health
coeliac disease
chrons
JCA

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12
Q

Staging of puberty; the tanner method

A 
B - 1-5 = breast development 
G - 1 - 5 = genital development 
PH - 1-5 pubic hair 
AH - 1-3 = axillary hair
T - 2 ml to 20ml 
SO - e.g. statement as B3 PH3 or G2 PH2 6/6
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13
Q

What is used to look at testicular maturation?

A

Prader orchidometer

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14
Q

When is early development in boys and is it common or rare?

A

< 9 years

Rare

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15
Q

When is delayed development in boys and is this common?

A

> 14 years

common, esp CDGP

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16
Q

When is early development in girls?

A

< 8 years

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17
Q

When is delayed development in girls and is this common?

A

> 13 y/o

rare

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18
Q

What does CDGP stand for?

A

Constitutional delay of growth and puberty

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19
Q

Who mainly gets CDGP?

A

Boys

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20
Q

Features of CDGP

A

FH in brothers or dads (difficult to obtain)

Bone age delay

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21
Q

What do you need to exclude in CDGP?

A

Organic disease

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22
Q

Causes of delayed puberty

A

CDGP
Gonadal dysgenesis (turner 45X, Klinefelter 47 XXY)
Chronic disease (crohn’s, asthma)
Impaired HPG axis (septo-optic dysplasia, craniopharyngioma, kallmans syndrome)
Peripheral (cryptorchidism, testicular irridation)

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23
Q

Presentation of early sexual development

A 
Breast development 
Secondary sexual characteristics
PV bleeding (early menarche)
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24
Q

Causes of early sexual development

A

Hypothalamic activation

Sex steroid hormone secretion

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25
Q

Presentation of central precocious puberty

A 
Pubertal development 
- breast development in girls
- testicular enlargement in boys
Growth spurt 
Advanced bone age
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26
Q

What do you need to exclude with central precocious puberty?

A

Pituitary lesion with an MRI

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27
Q

What is central precocious puberty?

A

Early sexual development

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28
Q

What is precocious pseudopuberty?

A

Abnormal sex steroid hormone secretion leading to partial pubertal development

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29
Q

Pathology of precocious pseudopuberty

A

Gonadotrophin independent

Low/prepubertal levels of LH and FSH

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30
Q

What do you need to exclude in precocious pseudopuberty?

A

Congenital adrenal hyperplasia

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31
Q

Management of ambiguous genitalia

A

Do not guess
Exam of gonads and internal organs
Karyotype

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32
Q

In ambigious genitalia what do you have to exclude and why?

A

Congenital adrenal hyperplasia

Risk of adrenal crisis in first 2 weeks of life

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33
Q

Causes of congenital hypothyroidism

A

Athyreosis / hypoplastic / ectopic

Dyshormonogenic

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34
Q

When should treatment for congenital hypothyroidism be started?

A

Within first 2 weeks

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35
Q

Most common cause of acquired hypothyroidism

A

Autoimmune (hashimotos) thyroiditis

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36
Q

Childhood issues of hypothyroidism

A

lack of height gain
pubertal delay (or precocity)
poor school performance (but work steadily)

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37
Q

Assessment of obesity

A 
weight 
BMI 
height 
waist circumference 
skin folds
history and exam 
complications
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38
Q

Obese + what is abnormal?

A

Short

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39
Q

Some Complications of obesity

A 
Fatty liver diseases
Repro dysfunction e.g. PCOS
Pancreatitis 
injuries 
Stress incontinence 
LVH
atherosclerotic CV disease 
Pancreatitis 
nutritional deficiencies
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40
Q

Causes of obesity

A 
Simple obesity
drugs
syndromes
endocrine disorders
hypothalamic damage
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41
Q

What is simple obesity?

A

Intake exceeds activity

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42
Q

Treatment of obesity

A

Diet
Exercise
Psychological input

43
Q

What is the most common cause of obesity?

A

Simple obesity

44
Q

Endocrine causes of obesity would also have signs of…..

A

Growth failure

45
Q

Syndrome causes of obesity would also have signs of ……

A

LDs

46
Q

Hypothalamic causes of obesity causes signs of…..

A

loss of appetite control

47
Q

Symptoms of T1DM in children (the 4Ts)

A

thirsty
thinner
tired
using toilet more

48
Q

What test to do and what result indicates T1DM in children?

A

Finger prick capillary glucose test

result > 11 mol/l

49
Q

What is a red flag symptom for diabetes?

A

A return to bedwetting or day wetting in a previously dry child

50
Q

Indicators of DM in children < 5 y / o

A 
Heavier than usual nappies
blurred vision 
candidiasis (oral, vulval)
constipation 
recurring skin infections
irritability, behaviour change
51
Q

Symptoms of DKA

A 
Nausea
Vomiting
Abdominal pain 
Sweet smelling ketotic breath 
drowsiness 
Dehydration > 5%
rapid, deep "sighing" respiration - hyperventilation 
coma
52
Q

Test if suspect DKA

A 
Serum blood ketones > 3 
VBG 
CBG
finger prick capillary blood glucose test 
- > 11mol/l
53
Q

Investigations if suspect DM

A

Finger prick blood glucose

Same day review with paediatrician

54
Q

What value of Finger prick blood glucose indicates DM?

A

> 11

55
Q

What is another name for psychogenic polydipsia?

A

Habitual drinking

56
Q

Features of habitual drinking vs DM symptoms

A

Habitual drinking - drink then pee

DM - Pee then drink as compensating

57
Q

Why in DKA do children have abdominal pain and vomiting?

A

GI upset

Trying to get rid of the acid

58
Q

What drives the acidosis in DKA?

A

Ketones

59
Q

Biochemical features of DKA

A 
Hyperglycaemia > 11
Ketosis (blood / urine)
Blood ketones > 3
Acidosis
- ph < 7.3
- HCO3 <15mmol/L
60
Q

What type of blood gases aren’t done in children?

A

Arterial (ABG)

61
Q

Treatment of DKA

A 
ABCDE
IV fluids by bolus (+sugar to the fluid) 
- resus 10ml/kg 0.9% saline)
- maintenance + deficit 0.9% saline + dex + K+
IV insulin (1 hour after fluids)
- 0.1u/kg/h (no bolus)
- never stop infusion unless SC started
Prevent cerebral oedema
62
Q

What must be avoided in the treatment of DKA?

A

BICARBONATE

63
Q

Who has the highest risk of cerebral oedema in DKA?

A

Late teens - early 20s

64
Q

Why do we check the electrolytes in DKA?

A

Vomiting
Giving fluids
Giving insulin brings down your K+

65
Q

Monitoring in DKA

A 
BG hourly 
Ketones hourly
Electrolytes 4 hourly 
Gases 4 hourly 
Basic obs 
Fluid input / output
Neuro obs 
ECG
Weight
Behavioural change / headache
66
Q

Presentation of cerebral oedema

A

Headache +/- vomiting
Irritability
Reduced consciousness level
Signs of increased ICP

67
Q

What % of DKA episodes have cerebral oedema?

A

1%

68
Q

Management of cerebral oedema

A 
Exclude hypoglycaemia 
Call for help 
MANNITOL 1g/kg IMMEDIATELY 
Fluid restriction 
Elevate head end of bed
Consider ITU
CT scan
69
Q

Examples of short acting insulins

A

Novorapid
Humalog
Actarapid

70
Q

Examples of long acting insulins

A

Glargine / lantus

Detemir / Levemir

71
Q

Example of a intermediate acting insulin

A

Insulatard

72
Q

Example of a mixed insulin

A

Novomix 30

73
Q

When would your long acting insulins be given?

A

Same time every day as provide 24 hour cover

74
Q

When are your short acting insulins given?

A

Before every meal

75
Q

What does the dose of the short acting insulin depend on?

A

CHO load of meal

BG

76
Q

What does the continuous subcutaneous insulin infusion allow?

A

Very small amounts of insulin to be delivered

Flexibility with activity and meals

77
Q

Where are the normal injection sites in children?

A

Buttocks
Thighs
Abdomen

78
Q

What is the commonest cause of polydipsia and polyuria in children?

A

Habitual drinking

79
Q

What must be excluded before diagnosing habitual drinking?

A

UTI

DM

80
Q

Management of habitual drinking

A 
Offer only water (especially at night)
Milk 500ml/day 
Decrease amounts of flavoured/sweetened fluid 
Re offer meals if not taken 
Avoid sugar based foods
81
Q

Presentation of central diabetes insipidus

A 
Polyuria
Polydipsia - may include "odd fluids" if cannot access normal ones
May not have nocturnal eneuresis 
Well otherwise
Glucose / urine normal (but dilute)
82
Q

Pathology of central DI

A

Deficient secretion of ADH by pituitary gland

83
Q

Causes of central DI

A

Brain abnormality in neonatal period

Brain tumour or brain injury in older group

84
Q

Investigations of central DI

A

MRI

85
Q

Treatment of Central DI

A

ADH analogue - desmopressin (DDAVP)

86
Q

Presentation of nephrogenic DI

A

Primary nocturnal eneuresis (never dry at night)
Polydipsia
- preferring water
- older child
May have tried desmopressin for NE but no effect
Mother may also drink 6 - 7L per day

87
Q

Pathology of nephrogenic DI

A

Defective or absent ADH receptor sites

Defective or absent aquaporin - trasports water at collecting duct

88
Q

Treatment of nephrogenic DI

A

Indomethacin
Hydrocholorthiazide
Amiloride

89
Q

Is diabetes insipidus common?

A

No

90
Q

What karyotype is associated with kleinfelters?

A

47, XXY

91
Q

Presentation of Kleinfelters syndrome

A

Taller than average
Lack of secondary sexual characteristics
Small, firm testes
Infertile
Gynaecomastia (increased incidence of breast ca)
ELEVATED gonadotrophins

92
Q

Diagnosis of Kleinfelters is done by what?

A

Chromosomal analysis

93
Q

What is Kallmans syndrome a recognised cause of?

A

Delayed puberty secondary to hypogonadotrophic hypogonadism

94
Q

Inheritance of Kallmans syndrome

A

X linked recessive

95
Q

Pathology of kallmans syndrome

A

Failure of GnRH secreting neurones to migrate to the hypothalamus

96
Q

What would be the clues in many questions for kallmans syndrome?

A

Anosmia in a boy with lack of puberty

97
Q

Presentation of kallmans syndrome

A 
Delayed puberty
Hypogonadism 
Cryptorchidism 
Anosmia 
Sex hormones LOW
LH and FSH levels are inappropriately LOW/NORMAL 
Typical normal or above average height  
Possibly
- cleft lip / palate
- visual / hearing deficits
98
Q

Inheritance of androgen insensitivity syndrome

A

X linked recessive

99
Q

Pathology of androgen insensitivity syndrome

A

End organ resistance to testosterone causing genotypically male children (46XY) to have the female phenotype.

100
Q

Another name for complete androgren insensitivity syndrome

A

Testicular feminisation syndrome

101
Q

Presentation of androgen insensitivity syndrome

A

Primary amenorrhea
Undescended testis causing groin swellings
Breast development may occur (due to conversion of testosterone to oestrogen)

102
Q

Diagnosis of androgen insensitivity syndrome

A

Buccal smear or chromosomal analysis to reveal 46XY chromosome

103
Q

Management of androgen insensitivity syndrome

A

Raise child as female
Bilateral orchidectomy
Oestrogen therapy

104
Q

Why would you do a bilateral orchidectomy in androgen insensitivity syndrome?

A

Increased risk of testicular cancer due to undescended testis

Paeds (28 decks)

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