Peds growth & endocrine issues
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What is the normal growth in cm during childhood?
What ages are the pubertal growth spurt(in cm/in) for boys and girls?
- Boys- 8-12cm (3-5inch)
- Girls - 10-14cm (4-6in)
T or F. Onset of pubertal growth spurt is often preceded by a "decline" in growth rate.
For north american boys, growth spurt usually occurs around what age?
What age is growth usually completed for boys? for girls?
- Boys--> completed by 19yo
- Girls --> completed by 14.5yo
What is the definition of pubertal delay?
-Child has passed time of expected puberty without hormonal/physical signs that puberty is beginning
What is "constitutional" delay?
-Temporary delay in skeletal growth and ht of a childen with no other physical abnormalities causing delay
T or F. no specific age cleanly separates pathologic from physiologic delay?
- True, but delay of 2-3yrs warrants evaluation
- - a delay of 2 SD is proposed as standard
What are 3 1st indicators of Pubertal Delay?
- 1. no breast development by 13
- 2. No menarche by 3 years after breast growth
- 3. No menarche by 16
In boys, what is 1st indicatore of pubertal delay?
No testicular growth by 14yo
KNOW: What are the 8 steps in Male puberty?
- 1. Growth of testicles
- 2. Pubic hair appears
- 3. Growth of penis
- 4. Axillary hair
- 5. First ejaculation
- 6. growth spurt
- 7. facial hair
- 8. Adult height
KNOW: Sequence of girl's puberty.
- 1. breast buds appear
- 2. pubic hair appears
- 3. growth spurt
- 4. axillary hair
- 5. pubic hair matures
- 6. breast mature
- 7. menarche
- 8. adult height
What is an example of puberty discordance?
Girl develops axillary hair w/out developing breast buds
3rd Pubertal delay indicators: reduced sense of smell suggests?
What are the parts of a good history for delayed puberty? (7)
- 1. When/if puberty commenced
- 2. level of exercise
- 3. nutritional intake
- 4. presence of stressors
- 5. sense of smell
- 6. symptoms of chronic illness
- 7. FH of puberty/delayed puberty
What are the PE parts of delayed puberty? (6)
- 1. growth patterns
- 2. body proportions
- 3. breast/genital development
- 4. pelvic exam
- 5. pelvic u/s
- 6. stigmata
What are 7 labs for evaluating delayed puberty?
- 1. CBC
- 2. ESR
- 3. CMP
- 4. LFTs
- 5. TSH
- 6. GH
- 7. HCG
What age is precocious female/male defined as?
- White girl- 7 or younger
- Black girl - 6 or younger
- boys - 8 or younger
What is significant about "bone age" in precocious puberty?
Bone age is ADVANCED
What age is premature thelarche?
Before the age of 6
T or F. Benign premature thelarche is thought to be a result of elevated circulating estrogen.
FALSE: thought to be due to increased end-organ sensitivity.
What are 3 patho causes of premature thelarche?
- 1. Low levels of estrogen secretion by normal follicular cysts
- 2. Increased sensitivity of breast tissue (environmental causes)
- 3. ovarian response to transient increases in FSH levels, possibly variations in ovarian sensitivity to FSH
T or F. Gynecomastia is seen frequently in newborns?
What are some pubertal causes of gynecomastia?
-influence of too little androgen and too much estrogen on mammory tissue
What percentage of boys are affected by gynecomastia (ages 10-16yo)?
What Tanner stage is gynecomastia most often seen?
tanner stage 2 or 3
When would surgical txt for gynecomastia be considered?
Pubertal: >4cm, especially if present for > 4years
How long is needed to make adequate judgements on growth pattern?
Discuss calculation for target height of girls and boys.
Girls--> M's ht + (D's ht - 5in)/2
Boys--> D's ht + (M's ht + 5in)/2
What abnormal height percentile needs a referral?
Growth <3rd percentile or >95th percentile
What growth velocity issues may need referral? (2)
- 1. Decrease/accelerated growth velocity for age
- 2. Falling out of growth channel
What are the 5 areas of growth findings that may need referral?
- 1. Height
- 2. Growth velocity
- 3. Genetic potential
- 4.Mult. syndromic/dysmorphic features
- 5. Bone age
KNOW: What are 2 normal causes of short stature?
- 1. Familial short stature
- 2. constitutional growth delay
KNOW: What are 7 pathologic causes of short stature?
- 1. nutritional
- 2. endocrine
- 3. chromosomal
- 4. IUGR
- 5. skeletal dysplasia
- 6. chronic illness
- 7. psychosocial
What is the criteria for defining short stature?
Ht below 2 SD or < 3rd percentile
Discuss "bone age". (3)
- 1. Anterposterior view of left hand or wrist
- 2. Correlates degree of physical maturation with chronological age
- 3. Base on fusion of growth plates
What a major cause of "advanced" bone age?
prolonged elevation of sex steriods (like precocious puberty, adrenal hyperplasia)
T or F. In genetic short stature, the bone age is EQUAL to chronological age?
True (have normal PE, growth rate > 4cm/yr, & appropriate bone age)
What is the most common cause of short stature?
- Constitutional Delay,
- -->falls off growth curve about 9-18mo and begins normal velocity
- --> Bone age delayed and about equal to ht
When does delayed pubertal growth spurt occur?
Between 15-17 with growth continuing until 18-20yo
What are 6 characteristics of Constitutional Growth Delay?
- 1. Deceleration in 1st 2 yrs, followed by normal
- 2. Both wt and ht decrease
- 3. Delayed bone age
- 4. delayed onset of puberty
- 5. Final ht appropriate for family
- 6. Mechanism unclear
T or F. < 4cm/yr ht growth can be caused by growth hormone deficiency.
What are the 2 major aspects of diagnosing GH deficiency?
- 1. Abnormal growth velocity
- 2. Delayed skeletal maturation
T or F. A short child with a normal growth rate is unlikely to have signficant illness or endocrinopahty.
True (but consider TSH, delayed bone age, growth rate <4cm/yr)
T or F. Many clinical features that are seen in hypothyroid adults are lacking in children.
What is the most common manifestation of Hypothyroidism in children?
What is the laboratory diagnosis of hypothyroidism?
Increased TSH, low T4
What are 2 genetic syndromes associated with hypothyroidism?
- 1. Down Syndrome
- 2. Turner's syndrome
What childhood disease is associated with autoimmune thyroid disorders?
List several PE findings in kids with hypothyroidism.
- 1. bradycardia
- 2. short stature (off chart)
- 3. goiter
- 4. myxedema
- 5. muscle hypertrophy but weakness
- 6. pale, cool, dry, carotenemic skin
- 7. increase in lanugo hair
What is the most sensitive thyroid marker for secondary/teriary hypothyroidism?
T or F. Children with hypothyroidism need an immediate referral to endocrinology.
Treat and also consult Endo but not emergent
What is the major cause of Acquired hypothyroidism?
Autoimmune or Hashimotos thyroiditis
What are some symptoms for acquired hypothyroidism?
- -Subtle findings
- -**Delayed growth, bone age, and dentition
- -increased wt for ht, developmental delays, delayed puberty
- -pale, cool, gray, mottled, thickened skin
What is the most common cause of mental retardation in the world?
Endemic cretinism (iodine deficiency)
T or F. Hyperthyroidism is uncommon in children
T or F. Most kids with Turner's Syndrome have no phenotypic characterstics except short stature.
What are 2 major contributors to DM2 in kids?
- 1. obestity
- 2. Lack of exercise
What are 7 labs for monitoring DM?
- 1. CMP
- 2. A1C q3 uncontrolled, q6 controlled
- 3. CBC
- 4. UA
- 5. TSH annually
- 6. Lipid q3-6mo
- 7. microalbumin
What are symptoms of calcium disorders?
-tetany with facial/extremity numbness, tingling, cramps
What labs may help assist in diagnosing hypocalcemia?
-24hr urine Ca/phosphate
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