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 growth
based on WHO Child Growth Standards
Hospital chart
THE Red Book
Weight and Height changes in time
head circumference up to 1yo
NB correction for prematurity up to 2 yo
0.4, 2, 9, 25, 50, 75, 91, 98, 99.6 centiles

6. Short Stature Causes hypopituitarism hypothyroidism Turner's syndrome
constitutional delay
pubertal delay
GH deficiency
Cushing's syndrome/ disease
skeletal disorder
chronic illness
malabsorption
congenital heart disease CF DM
immunodeficiency
hypopituitarism
hypothyroidism
Turner's syndrome
Emotional problems

7. Short Stature + 7cm (boys) -7 cm (girls) Height below 0.4th centile
Need ≥2 measurements 6 months apart
growth velocity important
height vs. mid-parental height (F+M)/2
trace the centile
+/- 10cm boy, +/- 8cm girls
History
childhood illness
FHx of skeletal disorders
Examination
growth charts!!!
dysmorphic features
weight
stage of puberty
+ 7cm (boys)
-7 cm (girls)

8. Short Stature Investigations Management bone age karyotype TFTs
GH and IGF-1
coeliac screen
inflammatory markers
Management
GH replacement
IGF-1 replacement if GH resistance
GH replacement works better when more GH deficient the child is
IGF1 replacement is expensive

9. LOOK AT EXAMPLES IN LISSAUER

10. Puberty defined sequence of changes leading to full sexual development
Female:
breast development ( years)
pubic hair growth
Rapid height spurt
menarche
Male:
Testicular enlargement
height spurt ©

11. Delayed puberty Boys > girls
Absence of pubertal development at 14 in girls and 15 in boys
Causes
constitutional delay most common
hypogonadotropic hypogonadism CF
anorexia
hypothyroidism
hypopituitarism
hypergonadotroipc hypogonadism
Turner's or Kleinefelter's syndromes
steroid enzyme deficiencies
gonadal damage

12. Delayed puberty ©hardballtalk.nbcsports.com Assessment Management
pubertal staging
growth staging
chronic systemic disorders
karyotype in girls
Management
treat the cause if possible
reassure!
accelerate growth and puberty if necessary
oxandrolone and later testosterone for boys
oestradiol for girls
psychologist's help
©hardballtalk.nbcsports.com

13. Precocious puberty Girls > boys Gonadotropin dependent
in girls often premature onset of normal puberty
Gonadotropin dependent
idiopathic
CNS abnormalities
hypothyroidism
Gonadotropin independent
CAH
granulosa cell tumours / Leydig cell tumours
exogenous sex steroids

14. Precocious puberty Management treat underlying cause if possible
reduce rate of skeletal maturation if necessary
early growth spurt -> early growth cessation -> lower adult height
GnRH analogues for gonadtropin-dependent
androgen / oestrogen inhibitors or antagonists for gonadotropin-independent

15. Turner's syndrome ©www.pinterest.com 45 X0 Clinical features:
most cases lead to early miscarriage
risk not affected by maternal age
Clinical features:
short stature (NB may be the only one)
webbed neck
cubitus valgus
widely spaced nipples
delayed puberty and ovarian dysgenesis
normal intelectual function
Management
GH replacement
oestrogen replacement at puberty time ©

16. Congenital adrenal hyperplasia
AR 21-hydroxylase deficiency
Presentation
virilisation of female infants
enlarged penis in male infants (rarely identified)
salt-losing crisis at 1-3 weeks of age
vomiting, weight loss, collapse
tall and muscular built
precocious pubarche
Management
glucocorticoid (to allow normal growth) ± mineralocorticoid replacement
monitor growth, skeletal maturity and androgens - avoid over-replacement
additional hormone replacement at times of stress
±corrective surgery in females

17. Hypothyroidism Congenital Acquired 1:4000 short stature
untreated leads to cretinism
causes
thyroid development anomalies
iodine deficiencies
TSH deficiency
usually picked up on Guthrie test before symptomatic
lifelong thyroxine replacement
Acquired
short stature
slipped upper femoral epiphysis
school work deterioration
other features as in adults

18. Type 1 diabetes mellitus
Autoimmune condition
Classic triad:
polydipsia
polyuria
weight loss
Treat by replacing insulin
MDT approach
sick day rules important to avoid DKA
education
monitoring and injection technique
basic pathology
diet
diet:
optimise control while maintainig growth
high fibre (sustained glucose release) 
carbohydrate counting ©

19. Diabetic ketoacidosis
Relative deficiency of insulin
Can be provoked by eg infection
importance of sick day rules
Triad of:
acidosis
ketonaemia
hyperglycaemia
Emergency treatment
rehydrate
fixed infusion rate insulin until ketones normalise
replace glucose and potassium as needed
SENIOR HELP NEEDED
identify reasons, educate!

20. Thank you! Remember the GROWTH CHART!
This sessions won't grow any better without your feedback!