Growth and nutrition

Question 1

Treatment for constitutional delay in growth and puberty

Answer 1

SOMETIMES small dose testosterone purely for QOL/psychological reasons to speed up process/initiate puberty

Question 2

Treatment for short stature due to SGA/extreme prematurity

Answer 2

GH may be indicated if insufficient catch-up growth by 4yrs

Question 3

If overweight children are relatively short (centile-wise) this suggests…

Answer 3

endocrine problem

Question 4

If overweight children are relatively tall (centile-wise) this suggests…

Answer 4

nutritional obesity

Question 5

Treatment for short stature due to growth hormone deficiency

Answer 5

biosynthetic GH given SC, usually daily

Question 6

What is laron syndrome characterised by?

Answer 6

GH insensitivity (due to defective GH receptors): high GH, low IGF-1

Question 7

How to calculate mid-parental height

Answer 7

MPH = (mother’s height + father’s height in cm)/2

+7cm if male
or -7cm if female

Question 8

How to calculate target parental range

Answer 8

TPR = MPH +/- 10cm if male, or +/- 8.5cm if female

Question 9

How to calculate height velocity

Answer 9

change in height/time

Question 10

How long should prematurity be taken into account for when assessing growth?

Answer 10

1-2yrs depending on degree of prematurity

Question 11

Criteria for weight faltering

Answer 11

1. a sustained drop down 2 centile spaces (crossing 2 lines)
2. weight <0.4th centile
3. BMI <2nd centile (in children >2yrs)

Question 12

What do tanner stages describe?

Answer 12

• stages of puberty from prepubertal/preadolescent to adult

- 5 stages for breast, pubic hair and male genitals

Question 13

1st sign of puberty in females and when it occurs

Answer 13

breast bud development, between 8.5-12.5yrs

Question 14

1st sign of puberty in males

Answer 14

testicular enlargement to >4ml

Question 15

Sequence of puberty in females

Answer 15

1. breast development
2. pubic hair growth and rapid growth spurt
3. menarche

Question 16

Sequence of puberty in males

Answer 16

1. testicular enlargement
2. pubic hair growth
3. rapid growth spurt

Question 17

What is premature sexual development?

Answer 17

development of secondary sexual characteristics <8yrs in females, or <9yrs in males

Includes: precocious puberty and isolated development of breasts/pubic hair/menarche

Question 18

Types of precocious puberty

Answer 18

Gonadotrophin-dependant (central (pituitary-driven) ‘true’ precocious puberty)

• premature activation of hypothalamic-pituitary-gonadal axis
• sequence is normal (consonant)

Gonadotrophin-independent (pseudo ‘false’ precocious puberty)

• excess sex steroids from outside pituitary gland
• sequence is abnormal (dissonant)

Question 19

How are the types of precocious puberty distinguished from one another?

Answer 19

• sequence of puberty (consonant or dissonant)

- gonadotrophin levels (LH/FSH)

Question 20

What is seen in true precocious puberty

Answer 20

• LH ++
• FSH +
• consonant puberty

Question 21

What is seen in false precocious puberty

Answer 21

• low LH
• low FSH
• dissonant puberty

Question 22

What is true precocious puberty usually due to?

Answer 22

Girls: premature onset of normal puberty, idiopathic/familial

Boys: often pathological cause, brain tumour (usually pituitary: craniopharyngioma)

Question 23

Assessing precocious puberty in females

Answer 23

• true PP fairly common - usually idiopathic/familial
• if dissonant (false), consider CAH/adrenal tumours
• US of ovaries and uterus
• ?cranial MRI
• can do bone age measurement

Question 24

Assessing precocious puberty in males

Answer 24

• true PP is uncommon
• exclude pathological causes - craniopharyngioma
• bilateral testicular enlargement >4ml suggests true PP
• prepubertal testes suggest false PP e.g. adrenal tumour, CAH
• unilateral enlarged testis suggests gonadal tumour
• cranial MRI
• can do bone age measurement

Question 25

Treatment for precocious puberty

Answer 25

MAY involve: - GnRH analogues: to suppress gonadotrophin release - inhibitors of androgen or oestrogen production or action

Question 26

What is delayed puberty?

Answer 26

absence of pubertal development by 13y in females (or no periods by 15y), or 14y in males

Question 27

Consequences of vit A deficiency

Answer 27

- increased susceptibility to infections (espeically measles) - night blindness, dry eyes/excessive blinking due to xeropthalmia

Question 28

Consequences of vit D deficiency

Answer 28

- rickets | - hypocalcaemia

Question 29

Signs of vit D deficiency

Answer 29

- sensation like pressing pingpong ball when pressing back of head (craniotabes) - frontal bossing of skull - rachitic rosary (palpable costochondral joints) - widened wrist and ankle joints - Harrison's sulcus - bowed legs - poor growth/short stature - features of hypocalcaemia: seizures, neuromuscular irritability, apnoea, stridor, cardiomyopathy

Question 30

Definitions of overweight and obese in children

Answer 30

overweight: BMI >91st centile obese: BMI >98th centile

Question 31

When to look for non-nutritional cause of obesity, and what to look for

Answer 31

- obese and short: endogenous cause e.g. Cushing's, hypothyroidism - LD/dysmorphic: syndrome e.g. Prader-Willi - severely obese <3y: gene defect e.g. leptin deficiency