Growth & Puberty

Question 1

Four phases of growth

Answer 1

Fetal
Infant
Child
Pubertal

Question 2

Factors affecting size of fetus

Answer 2

Size of the mother 
Placentl nutrition (which modulates fetal growth factors)

Question 3

Three examples of fetal growth factors

Answer 3

IGF2
Human placental lactogen
Insulin

Question 4

What is the fastest period of growth?

Answer 4

Fetal

Question 5

What is the effect of precocious puberty on stature?

Answer 5

Often shorter because earlier fusion of epiphyseal growth plates

Question 6

Factors influencing infantile growth

Answer 6

Nutrition
Thyroid
Happiness

Question 7

Factors influencing childhood growth

Answer 7

Thyroid
GH (IGF-1)
Happiness
Genes

Question 8

Factors influencing pubertal growth

Answer 8

GH

Sex steroids

Question 9

First sign of puberty in females. Age?

Answer 9

Breast enlargement (8.5-12.5 years)
Growth spurt shortly after

Question 10

First sign of puberty in males. Age?

Answer 10

Testicular enlargement (>4ml vol). 9-13 years 
Growth spurt 18mos after

Question 11

Commonest cause of cushing syndrome in children

Answer 11

Excess steroids

Question 12

8 causes of short stature

Answer 12

Familial
Constitutional delay
Severe IUGR/preterm

Endocrine (thyroid, GH, IGF1)

Nutrition/chronic illness
Psychosocial

Syndromes
Skeletal abnormalities

Question 13

Commonest cause of hypothyroid causing short stature

Answer 13

Autoimmune thyroiditis

Question 14

Features of children with endocrine caused short stature

Answer 14

Often weight > height centile

Question 15

Features of children with short stature caused by nutrition/chronic illness

Answer 15

Falling off centiles

Weight < height centile

Question 16

Chronic illnesses commonly causing short stature

Answer 16

Coeliac
IBD (Crohn’s)
CKD

Question 17

Features of children with short stature due to constitutional delay

Answer 17

Leg growth is more mature than spine growth (pubertal growth is focused in the spine)

Question 18

Causes of constitutional delay

Answer 18

Familial

Diet/exercise

Question 19

Which syndromes can cause short stature

Answer 19

Turners
Noonan
Down
Russell-Silver

Question 20

Investigations for short stature

Answer 20

Growth charts
Clinical features
Bone age

FBC (Anaemia - coeliac/crohn’s)
Bone profile
TFTs
CRP/ESR (Crohn’s, chronic illness)

GH provocation tests
IGF-1

Karyotype

Abs (coeliac)

Question 21

How is bone age determined

Answer 21

X ray of hand and wrist

Question 22

Precocious puberty girls

Answer 22

8 years

Question 23

Precocious puberty boys

Answer 23

9 years

Question 24

Delayed puberty girls

Answer 24

13 years

Question 25

Delayed puberty boys

Answer 25

14 years

Question 26

Two types of precocious puberty

Answer 26

Gonadotrophin dependent (central) Gonadotrophin independent

Question 27

Cause of precocious puberty in girls

Answer 27

Mostly familial/idiopathic

Question 28

Cause of precocious puberty in boys

Answer 28

More likely to have organic cause - Gonadal tumour (unilateral testis enlargement) - Adrenal issue (bilateral small testes) - Gonadotrophin release - from intracranial lesion (bilateral testes enlargement)

Question 29

Central precocious puberty management

Answer 29

``` GnRH agonist GH therapy (GnRH agonists can stunt growth) ```

Question 30

What should be given with GnRH agonists to avoid growth stunting?

Answer 30

GH therapy

Question 31

Three types of delayed puberty

Answer 31

Constitutional Hypogonadotrophic hypogonadism Hypergonadotrophic hypogonadism

Question 32

Is delayed puberty more common in boys or girls?

Answer 32

Boys

Question 33

Examples of Hypogonadotrophic hypogonadism

Answer 33

- Diet/exercise - Systemic disease, e.g. CF, Crohn's, asthma - Acquired hypothyroidism - Hypothalamic-pituitary problems, e.g. tumours/Kallman's

Question 34

Examples of Hypergonadotrophic hypogonadism

Answer 34

- Turner's - Klinefelter's - Steroid hormone enzyme deficiencies - Acquired gonadal damage

Question 35

Mx delayed puberty in boys

Answer 35

OBSERVE Oxandrolone - weak androgenic anabolic steroid induces catch up growth but not secondary sexual characteristics

Question 36

Mx delayed puberty in females

Answer 36

OBSERVE Short course oestrogen