Paediatric Endocrinology and Diabetes

Question 1

What are the measurement techniques used to assess normal growth and pubertal development?

Answer 1

Height
Length (babies)
Sitting height
Head circumference

Question 2

What factors can influence height?

Answer 2

Age
Sex 
General health 
Puberty 
Skeletal maturity 
Specific growth disorders 
Parental heights 
Nutrition

Question 3

What are the indications for referral of growth disorders?

Answer 3

Extreme short or tall statures 
Height below target height 
Abnormal height velocity (crossing centiles) 
History of chronic disease 
Obvious dysmorphic system 
Early/late puberty

Question 4

What are common causes for short stature?

Answer 4

Familial
Constitutional
Small for gestational age

Question 5

What are the pathological causes of short stature?

Answer 5

Undernutrition 
Iatrogenic (steroids) 
Chronic illness (JCA, IBD, coeliac) 
Hormonal (GHD, hypothyroidism) 
Syndromes (Turner, Prader-Willi, Noonan's) 
Psychological and social

Question 6

What does GHD stand for?

Answer 6

Growth hormone deficiency

Question 7

What are the general ranges for puberty in boys?

Answer 7

<9 yrs (early) >14 yrs (delayed)

Question 8

What are the general ranges for puberty in girls?

Answer 8

<8 yrs (early) >13 (delayed)

Question 9

What does SGA stand for?

Answer 9

Small for gestational age

Question 10

What is the most important pubertal stage for girls?

Answer 10

B2

Question 11

What is the most important pubertal stage for boys?

Answer 11

T3-4 ml

Question 12

What are some of the causes of delayed puberty?

Answer 12

Gonadal dysgenesis (Turner 45X, Klinefelter 47XXY)
Chronic disease (Crohn’s, asthma)
Impaired HPG axis
Peripheral (cryptorchidism, testicular irradiation)

Question 13

What are the clinical signs of central precocious puberty?

Answer 13

Pubertal development
Growth spurt
Advanced bone age

Question 14

What is the treatment for central precocious puberty?

Answer 14

GnRH agonist

Question 15

What are the clinical signs of precocious pseudopuberty?

Answer 15

Abnormal sex steroid hormone secretion
Gonadotrophin independent (Low levels of LH and FSH)
Viralising or feminasing

Question 16

What is the management approach for ambiguous genitalia?

Answer 16

Karyotype
Examination of gonads and internal organs
Exclude congenital adrenal hyperplasia

Question 17

What are the causes of congenital hypothyroidism?

Answer 17

Athyreosis/hypoplastic/ectopic

Dyshormonogenic

Question 18

What is the most common cause of acquired hypothyroidism?

Answer 18

Autoimmune (Hashimoto’s) thyroiditis

Question 19

What are the childhood issues associated with acquired hypothyroidism?

Answer 19

Lack of height gain
Pubertal delay or precocity
Poor school performance

Question 20

What is the definition of overweight?

Answer 20

BMI> 85th centile or SD>1.04

Question 21

What is the definition of obese?

Answer 21

BMI> 97.5th centile or SD>2

Question 22

What are the main causes if obesity?

Answer 22

Drugs
Syndromes
Endocrine disorders
Hypothalamic damage

Question 23

What drugs can be associated with obesity?

Answer 23

Insulin
Steroids
Antithyroid drugs
Sodium valproate

Question 24

What syndromes are associated with obesity?

Answer 24

Prader Willi syndrome
Laurence-Moon-Niedl syndrome
Down’s syndrome
Pseudohypoparathyroidism type 1

Question 25

What endocrine disorders are associated with obesity?

Answer 25

``` Hypothyroidism Growth hormone deficiency Glucocorticoid excess Hypothalamic lesion Androgen excess Leptin deficiency ```

Question 26

What is the treatment for obesity?

Answer 26

Diet Exercise Psychological input Drugs

Question 27

What are the symptoms of childhood diabetes?

Answer 27

``` Thirsty Thinner Tired Use of toilet more often Return to bed wetting Constipation Blurred vision Behavioural changes ```

Question 28

What is an immediate test for childhood diabetes?

Answer 28

Finger prick capillary glucose test >11mmol/L

Question 29

What are the symptoms of diabetic ketoacidosis?

Answer 29

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

Question 30

What is the test for diabetic ketoacidosis?

Answer 30

Finger prick glucose test >11mmol/L