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ENRP Exam 2 > Peds Endocrine > Flashcards

Peds Endocrine Flashcards

1
Q

What information is gathered by a single point on a growth chart?

A

Only gives information about how the child plots on the curve that day; need multiple points to evaluate the growth pattern (only way to evaluate if the rate of growth is adequate)

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2
Q

What is considered a normal BMI?

A

18.5-24.9

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3
Q

What is the normal growth velocity for school age children (ages 5 to puberty)?

A

5cm/year (2in/year)

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4
Q

What is the first parameter MC affected in children with endocrine growth disorders?

A

Length or height

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5
Q

What is considered to be a delayed bone age?

A

A bone age that is 2 standard deviations or more below the chronological age of the pt

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6
Q

What growth parameters are included on a growth chart?

A

Height/length, weight, BMI, and head circumference

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7
Q

If weight is the parameters that changes first or most dramatically on the growth chart what should you think of?

A

Think calories/nutrition (not getting fed enough, not retaining calories due to GERD or malabsorption, higher metabolic demands due to hyperthyroidism, congenital heart dz, etc)

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8
Q

If head circumference is the parameters that changes first or most dramatically on the growth chart what should you think of?

A

Think brain/skull or hydrocephalus

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9
Q

What is the definition for short stature?

A

Height that is >2 SDs below the mean height for age and sex (height would be in the 3rd percentile on the growth chart)

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10
Q

What are familial cause of short stature?

A

Parents are small; grows with normal velocity in all parameters but plot lower on the growth curve and end height is consistent with mid parental height; bone age is consistent with chronological age

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11
Q

What are constitutional causes of short stature?

A

Grow at a low normal rate and plot low on the growth curve; puberty is delayed; usually a FHx of late bloomers; puberty and growth spurts occur later, end height is normal; the hallmark of constitutional delay is delayed bone age

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12
Q

What are idiopathic cause of short stature?

A

Height greater than 2 SD below the mean height for that age; no endocrine, metabolic or other dx present; no FHx of short stature; bone age is consistent with chronological age

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13
Q

What is IGF-1?

A

A hormone that functions as the major mediator of GH stimulated somatic growth

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14
Q

What is IGFP3?

A

Main IGF-1 transport protein in the blood stream

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15
Q

What increases IGF-1 synthesis?

A

GH through osteoblast and chondrocytes suggesting that it contributes to statural growth

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16
Q

What would the levels of IGF-1 and IGFBP3 be in a person with short stature?

A

Decreased levels of IGF-1 and IGFBP3 levels are consistent with GH deficiency

17
Q

What should be performed if IGF-1 and IGFBP3 levels are decreased?

A

GH stimulation testing should be performed via administration of glucagon, administration of arginine or insulin induced hypoglycemia

18
Q

What is precocious puberty?

A

The onset of secondary sexual characteristics before 8 yo in girls and before 9 yo in boys

19
Q

What are additional findings used to make the dx of precocious puberty?

A

In girls: progressive breast development and crossing major percentile lines upward on the linear growth chart; in boys: evidence of both testicular and penile enlargement and crossing major percentile lines upward on the linear growth chart; rate of growth is fast initially but overall end height is less than it would normally be

20
Q

What is the work up for suspected precocious puberty?

A

Complete Hx and PE, labs (LH, FSH, estradiol/testosterone, 17-hydroxyprogesterone), imaging (bone age, MRI of the head, US of gonads)

21
Q

What are the dysmorphic features of Turner syndrome?

A

Short stature, wide shield shaped chest, wide spaced hypoplastic nipples, excess skin at back of neck/webbed neck, gonadal dysgenesis (streak ovaries by puberty), horseshoe kidney, congenital heart dz

22
Q

What causes premature adrenarche?

A

A benign condition caused by early maturation of zona reticularis of the adrenal gland with associated increased androgen secretion

23
Q

When is a work up warranted for a pt with premature adrenarche?

A

In pts with premature pubarche, when associated with other secondary sex characteristics and or bone age advanced >2SD from the normal age, when associated with significant growth acceleration

24
Q

Whether benign or associated with precocious puberty, a pt with premature adrenarche should be what?

A

Monitored clinically closely

25
Q

When is a work up warranted in a pt with premature thelarche?

A

When associated with other signs of secondary sex maturation, if associated with accelerated growth, when the bone age is advanced beyond 2 SD for the age

26
Q

What is congenital hypothyroidism?

A

Inadequate thyroid hormone production in newborn infants; secondary to absence, dysgenesis, or abnormal function of the thyroid gland

27
Q

What are the sx of congenital hypothyroidism?

A

Hoarse cry, course facies, lethargy, feeding problems, constipation, macroglossia, large fontanelles, hypotonia, prolonged jaundice

28
Q

What is the MCC of acquired hypothyroidism?

A

Autoimmune thyroiditis

29
Q

What are the clinical manifestations of autoimmune thyroiditis?

A

Declining grwoth velocity/short stature, abnormal pubertal development, declining school performance, sluggishness, fatigue, cold intolerance, constipation, dry skin, brittle hair, facial puffiness, muscle aches

30
Q

What is the primary determinant of normal post natal growth and skeletal maturation?

A

T3

31
Q

What is an important regulator of bone and mineral metabolism in older children and adults?

A

T3

32
Q

What does bone age assessment provided?

A

A rough estimate of a child’s skeletal maturation by assessing the ossification of the epiphyseal centers

33
Q

What is “catch up” or “catch down” growth?

A

Occurs in the first 18 months of life; some kids make up to a 25% downward correction on the growth curve (often occurs as more table food is introduced)

34
Q

If a child is less than 36 mo of age how should length be measured?

A

Using the 0-36 month curve, length is measured while the child is supine

35
Q

How should height be measured in a child that is older than 24 mo?

A

May use the 2-20 yo chart but the height must be measured standing up (stature)

36
Q

With delayed puberty/short stature in females, what should always be checked?

A

A karyotype

37
Q

Can short stature occur in the absence of other clinical features?

A

Yes

ENRP Exam 2 (9 decks)

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