growth and endocrine Flashcards
(54 cards)
Factors which affect growth:
- Age
- Sex
- Race
- Nutrition
- Parental heights
- Puberty
- Skeletal maturity (bone age)
- General health
- Chronic disease
- Specific growth disorders
- Socio-economic status
- Pyscho-social deprivation: Emotional well being
Key questions when assessing growth?
Is the kid too short or tall for their age
Has puberty started and is it progressing normally?
Is growth normal for stage of puberty?
Is child underweight, overweight or obese?
What is the most rapid phase if growth?
early in infantile phase (02)
What is involved in the assessment of puberty?
girls: pubic, axillary hair and breast development
boys: pubic, axillary hair and genital development in bonds
What is the onset of puberty in girls and boys?
girls: breast budding (tanner stage B2)
11years
Boys: testicular enlargement (tanner stage G2)
average age 11.5
difference in timeline in boy and girl puberty?
girls rapidly at start
boys start to accelerate until mid-puberty, 2 years later
why are boys taller?
more intense growth spurt
it starts 2 years laters
what is used to assess height?
stadiometer
when to measure an infant?
measure length without nappy or footwear before age of 2 years.
discrepancy when moving from supine to standing as it squares intervertebral disc
parent height comparator
the child’s most recent height centile up to age 8 gives a good idea of adult height for healthy children.
compare mid-parental gentile to the child’s current height gentile
9/10 children’s height gentile are with +/- within two gentile spaces of mid-parental centile
only 1 percent more than 3 gentile spaces below
what is just as important as measuring height?
Weight!
bmi equation?
weight (kg) / height m squared
what is an average weight of a child?
vmi between 25th and 75th percentile
what is ‘normal’ growth?
Precise definition difficult:
– Wide range within healthy population
– Different ethnic subgroups
– Inequality in basic health and nutrition
– Normality may relate to individuals or populations (genetic influence)
Bone age
/
What assessment tools are used for growth?
- Height/ length/ weight
- Growth Charts and plotting
- MPH and Target centiles
- Growth velocity
- Bone age
- Pubertal assessment
What is specifically looked at during history and examination?
- Birth weight
- gestation
- PMH
- Family history/social history/schooling
- Systematic enquiry- Dysmorphic features
- Systemic examination including pubertal assessment
what are indication for referral if you suspect a growth disorder?
- 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
common causes of short stature?
- Familial
- Constitutional
- SGA/IUGR
what tests should be done for short state?
- FBC and ferritin: gen health, coeliac, Chrons, JCA
- U&E, LFT, Ca, CRP: general disorders, renal and liver disease, disorders of Ca metabolism
- Coeliac serology and IgA- coeliac
- IGF-1, TFT, Prolactin, Cortisol, (gonadotrophins and sex hormones)- hormonal disorder
- Karyotype/ Microarray - Turner’s syndrome, chromosomal abnormalities
How to stage puberty?
Tanner method?
tanner puberty- explained
B: 1-5 (breast development) • G 1-5 (gentital development) • PH 1-5 (pubic hair) • AH 1-5 (axillary hair) •T 2ml to 20ml
• SO eg statement as B3 PH3 or G2 PH2 6/6
Hormons in puberty?
Hypothalmus - GnRH
Pituitary gland- LH, FSH
Boys: Testosterone
Girls: Estradiol
when is it early and delayed puberty in boys?
early<9years (rare)
– delayed >14 (common, especially CDGP)
