1 Paediatrics Endocrine problems - key facts Wojciech Cymes
2 Plan GROWTH CHARTS short stature puberty problems hypothyroidism CAH diabetes
3 Growth Charts UK-WHO growth charts, 0-18 years children of the same age and maturity who have shown optimum growthbased on WHO Child Growth StandardsHospital chartTHE Red BookWeight and Height changes in timehead circumference up to 1yoNB correction for prematurity up to 2 yo0.4, 2, 9, 25, 50, 75, 91, 98, 99.6 centiles
7 Short Stature + 7cm (boys) -7 cm (girls) Height below 0.4th centile Need ≥2 measurements 6 months apartgrowth velocity importantheight vs. mid-parental height (F+M)/2trace the centile+/- 10cm boy, +/- 8cm girlsHistorychildhood illnessFHx of skeletal disordersExaminationgrowth charts!!!dysmorphic featuresweightstage of puberty+ 7cm (boys)-7 cm (girls)
8 Short Stature Investigations Management bone age karyotype TFTs GH and IGF-1coeliac screeninflammatory markersManagementGH replacementIGF-1 replacement if GH resistanceGH replacement works better when more GH deficient the child isIGF1 replacement is expensive
11 Delayed puberty Boys > girls Absence of pubertal development at 14 in girls and 15 in boysCausesconstitutional delay most commonhypogonadotropic hypogonadismCFanorexiahypothyroidismhypopituitarismhypergonadotroipc hypogonadismTurner's or Kleinefelter's syndromessteroid enzyme deficienciesgonadal damage
13 Precocious puberty Girls > boys Gonadotropin dependent in girls often premature onset of normal pubertyGonadotropin dependentidiopathicCNS abnormalitieshypothyroidismGonadotropin independentCAHgranulosa cell tumours / Leydig cell tumoursexogenous sex steroids
14 Precocious puberty Management treat underlying cause if possible reduce rate of skeletal maturation if necessaryearly growth spurt -> early growth cessation -> lower adult heightGnRH analogues for gonadtropin-dependentandrogen / oestrogen inhibitors or antagonists for gonadotropin-independent
16 Congenital adrenal hyperplasia AR 21-hydroxylase deficiencyPresentationvirilisation of female infantsenlarged penis in male infants (rarely identified)salt-losing crisis at 1-3 weeks of agevomiting, weight loss, collapsetall and muscular builtprecocious pubarcheManagementglucocorticoid (to allow normal growth) ± mineralocorticoid replacementmonitor growth, skeletal maturity and androgens - avoid over-replacementadditional hormone replacement at times of stress±corrective surgery in females
17 Hypothyroidism Congenital Acquired 1:4000 short stature untreated leads to cretinismcausesthyroid development anomaliesiodine deficienciesTSH deficiencyusually picked up on Guthrie test before symptomaticlifelong thyroxine replacementAcquiredshort statureslipped upper femoral epiphysisschool work deteriorationother features as in adults
19 Diabetic ketoacidosis Relative deficiency of insulinCan be provoked by eg infectionimportance of sick day rulesTriad of:acidosisketonaemiahyperglycaemiaEmergency treatmentrehydratefixed infusion rate insulin until ketones normalisereplace glucose and potassium as neededSENIOR HELP NEEDEDidentify reasons, educate!
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