Peds growth & endocrine issues

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choward04
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205395
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Peds growth & endocrine issues
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2013-03-06 12:21:53
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Peds endocrine
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Pediatric growth & endocrine issues
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  1. What is the normal growth in cm during childhood?
    5.0-6.5cm/yr
  2. What ages are the pubertal growth spurt(in cm/in) for boys and girls?
    • Boys- 8-12cm (3-5inch)
    • Girls - 10-14cm (4-6in)
  3. T or F.  Onset of pubertal growth spurt is often preceded by a "decline" in growth rate.
    True
  4. For north american boys, growth spurt usually occurs around what age?
    14 years
  5. What age is growth usually completed for boys? for girls?
    • Boys--> completed by 19yo
    • Girls --> completed by 14.5yo
  6. What is the definition of pubertal delay?
    -Child has passed time of expected puberty without hormonal/physical signs that puberty is beginning
  7. What is "constitutional" delay?
    -Temporary delay in skeletal growth and ht of a childen with no other physical abnormalities causing delay
  8. 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
  9. 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
  10. In boys, what is 1st indicatore of pubertal delay?
    No testicular growth by 14yo
  11. 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
  12. 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
  13. What is an example of puberty discordance?
    Girl develops axillary hair w/out developing breast buds
  14. 3rd Pubertal delay indicators: reduced sense of smell suggests?
    Kallman syndrome
  15. 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
  16. 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
  17. What are 7 labs for evaluating delayed puberty?
    • 1. CBC
    • 2. ESR
    • 3. CMP
    • 4. LFTs
    • 5. TSH
    • 6. GH
    • 7. HCG
  18. What age is precocious female/male defined as?
    • White girl- 7 or younger
    • Black girl - 6 or younger
    • boys - 8 or younger
  19. What is significant about "bone age" in precocious puberty?
    Bone age is ADVANCED
  20. What age is premature thelarche?
    Before the age of 6
  21. 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.
  22. 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
  23. T or F. Gynecomastia is seen frequently in newborns?
    True
  24. What are some pubertal causes of gynecomastia?
    -influence of too little androgen and too much estrogen on mammory tissue
  25. What percentage of boys are affected by gynecomastia (ages 10-16yo)?
    40%
  26. What Tanner stage is gynecomastia most often seen?
    tanner stage 2 or 3
  27. When would surgical txt for gynecomastia be considered?
    Pubertal: >4cm, especially if present for > 4years
  28. How long is needed to make adequate judgements on growth pattern?
    6mo
  29. 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
  30. What abnormal height percentile needs a referral?
    Growth <3rd percentile or >95th percentile
  31. What growth velocity issues may need referral? (2)
    • 1. Decrease/accelerated growth velocity for age
    • 2. Falling out of growth channel
  32. 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
  33. KNOW: What are 2 normal causes of short stature?
    • 1. Familial short stature
    • 2. constitutional growth delay
  34. 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
  35. What is the criteria for defining short stature?
    Ht below 2 SD or < 3rd percentile
  36. 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
  37. What a major cause of "advanced" bone age?
    prolonged elevation of sex steriods (like precocious puberty, adrenal hyperplasia)
  38. 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)
  39. 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
  40. When does delayed pubertal growth spurt occur?
    Between 15-17 with growth continuing until 18-20yo
  41. 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
  42. T or F.  < 4cm/yr ht growth can be caused by growth hormone deficiency.
    True
  43. What are the 2 major aspects of diagnosing GH deficiency?
    • 1. Abnormal growth velocity
    • 2. Delayed skeletal maturation
  44. 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)
  45. T or F.  Many clinical features that are seen in hypothyroid adults are lacking in children.
    True
  46. What is the most common manifestation of Hypothyroidism in children?
    Growth failure
  47. What is the laboratory diagnosis of hypothyroidism?
    Increased TSH, low T4
  48. What are 2 genetic syndromes associated with hypothyroidism?
    • 1. Down Syndrome
    • 2. Turner's syndrome
  49. What childhood disease is associated with autoimmune thyroid disorders?
    DM1
  50. 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
  51. What is the most sensitive thyroid marker for secondary/teriary hypothyroidism?
    Free T4
  52. T or F. Children with hypothyroidism need an immediate referral to endocrinology.
    Treat and also consult Endo but not emergent
  53. What is the major cause of Acquired hypothyroidism?
    Autoimmune or Hashimotos thyroiditis
  54. 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
  55. What is the most common cause of mental retardation in the world?
    Endemic cretinism (iodine deficiency)
  56. T or F. Hyperthyroidism is uncommon in children
    True
  57. T or F.  Most kids with Turner's Syndrome have no phenotypic characterstics except short stature.
    True (45,X)
  58. What are 2 major contributors to DM2 in kids?
    • 1. obestity
    • 2. Lack of exercise
  59. 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
  60. What are symptoms of calcium disorders?
    -tetany with facial/extremity numbness, tingling, cramps
  61. What labs may help assist in diagnosing hypocalcemia?
    -24hr urine Ca/phosphate

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