Growth and Endocrine

Question 1

List factors that influence height?

Answer 1

Age, Sex, Race, Nutrition, Parental heights, Puberty, Skeletal maturity (bone age), General health, Chronic disease, Specific growth disorders, Socio-economic status, Emotional well-being

Question 2

Where are the two main spikes in growth in childhood?

Answer 2

Infantile period

Puberty

Question 3

What may be measured in children?

Answer 3

Length (Babies)
Height
Sitting height
Head Circumference (<2yrs)

Question 4

What may be used to measure growth in specific medical conditions affecting height?

Answer 4

Condition specific growth charts

Question 5

What method of estimating age can be achieved with radiographs?

Answer 5

Bone age

Question 6

What may be assessed on history and examination of a child with abnormal growth pattern?

Answer 6

Birth weight and gestation
PMH
Family history/social history/schooling
Systematic enquiry
Dysmorphic features
Systemic examination including pubertal assessment

Question 7

What would be indications for referral for growth disorder?

Answer 7

Extreme short or tall stature
Height below target height
Abnormal height velocity
History of chronic disease
Obvious dysmorphic syndrome
Early/late puberty

Question 8

What are some common causes of short stature?

Answer 8

Familial
Constitutional delay
SGA/IUGR

Question 9

What are some pathological causes of short stature?

Answer 9

Undernutrition
Chronic illness (JCA, IBD, Coeliac)
Iatrogenic (steroids)
Psychological and social
Hormonal (GHD, hypothyroidism)
Syndromes (Turner, P-W)

Question 10

What investigations may be used to investigate growth disorders?

Answer 10

FBC and ferritin
U+E, LFT, Ca, CRP
Coeliac serology + IgA
IGF-1, TFT, Prolactin, Cortisol
Karyotype

Question 11

What physical characteristics are used to measure staging of puberty in Tanner staging?

Answer 11

Breast development
Genital development
Pubic hair
Axillary hair
Testes size

Question 12

What can be used to measure testicular maturation?

Answer 12

Prader Orchidometer

Question 13

What is considered early puberty in boys?

Answer 13

<9yrs (Rare)

Question 14

What is considered early puberty in girls?

Answer 14

<8yrs

Question 15

What is considered late puberty in boys?

Answer 15

> 14yrs (Common, especially CDGP)

Question 16

What is considered late puberty in girls?

Answer 16

> 13yrs (Rare)

Question 17

What factors may suggest constitutional delay of growth and puberty (CDGP)?

Answer 17

Boys mainly
Family history in dad or brothers
Bone age delay

Question 18

What are some pathological causes of delayed puberty?

Answer 18

• 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)

Question 19

What are some possible causes of early breast development?

Answer 19

Central precocious pubery
Infantile thelarche
Thelarche variant

Question 20

What are some possible causes of early secondary sexual characteristics?

Answer 20

Precocious pseudopuberty (ie Congenital adrenal hyperplasia)
Exaggerated adrenarche

Question 21

What are some possible causes of early PV bleeding?

Answer 21

Premature menarche

Question 22

What are some signs of central precocious puberty?

Answer 22

Pubertal development (Breats, Testicular enlargement)
Growth spurt
Advanced bone age

Need to exclude pituitary lesion - MRI

Question 23

What are some signs of precocious pseudopuberty?

Answer 23

Abnormal sex steroid hormone secretion
Gonadotrophin independent (low levels of LH and FSH)
Clinical picture - secondary sex characteristics

Need to exclude congenital adrenal hyperplasia

Question 24

What is the management approach of ambiguous genitalia?

Answer 24

• Do not guess sex
• Multidisciplinary approach
• Exam - gonads?/internal organs
• Karyotype
• Exclude Congenital Adrenal Hyperplasia (Risk of adrenal crisis)

Question 25

What are some causes of congenital hypothyroidism?

Answer 25

- Athyreosis/hypoplastic/ectopic | - Dyshormonogenic

Question 26

What may suggest acquired hypothyroidism in children?

Answer 26

- Lack of height gain - Pubertal delay (or precocity) - Poor school perfomrance -Family history of thyroid/autoimmune disorders

Question 27

How would you assess obesity in children?

Answer 27

- Weight - BMI - Height - Waist circumference - Skin folds - History and exam - Complications

Question 28

Are obese children normally taller or shorter for their age?

Answer 28

Taller Obese + Short = abnormal sign

Question 29

What details may you explore in a history of obesity in a child?

Answer 29

- Diet - Physical activity - Family history - Symptoms suggestive of syndrome, Hypothalamic-pituitary pathology, Endrocrinopathy, Diabetes

Question 30

List some potential symptoms of type 1 diabetes in children

Answer 30

Thirsty Thinner Tired Using toilet more

Question 31

What is the test for diabetes?

Answer 31

Finger prick capillary glucose test If result > 11 mmol/L, telephone specialist team urgently for review

Question 32

What would be a red flag symptom of diabetes in young children?

Answer 32

Return to bedwetting or day-wetting

Question 33

What symptoms are suggestive of DKA?

Answer 33

``` Nausea and vomiting Abdominal pain Sweet smelling, 'ketotic' breath Drowsiness Rapid, deep sighing respiration Coma ```

Question 34

What are some symptoms that may suggest diabetes in a child under five?

Answer 34

``` Heavier than usual nappies Blurred vision Candidiasis Constipation Recurring skin infections Irritability, behaviour change ```