Endocrine

Question 1

Which measurements are essential for assessing growth?

Answer 1

• Length/height
• Weight
• OFC
• Bone age
• Pubertal assessments
• MPH and target gentiles
• Growth charts and plotting

Question 2

Short stature for age aetiology

Answer 2

• FH
• Constitutional
• SGA/IUGR

Pathological 
•Undernutrition
•Chronic illness (JCA, IBD, Coeliac)
•Iatrogenic (steroids)
•Psychological and social
•Hormonal (GHD, hypothyroidism)
•Syndromes (Turner, P-W)

Question 3

What investigations would you do for short stature?

Answer 3

• FBC and ferritin
• U&Es
• LFTs
• Ca
• CRP
• Coeliac serology and IgA : Coeliac disease
• IGF-1, TFTs, prolactin, cortison : Hormonal disorders
• Karyotype : Tuner’s syndrome

Question 4

Tanner method

Answer 4

B: breast development  1-5
G: genital development  1-5 
PH: pubic hair 1-5 
AH: axillary hair 1-3 
T : testes  2 ml to 20ml

Question 5

What do you use to assess testicular size?

Answer 5

ORCHIDOMETER

Question 6

Normal pubertal development in girls

Answer 6

Breast budding at 10-11

Early breast development 12-13

Question 7

When do girls stop growing?

Answer 7

Once they have got their first menstrual period

Question 8

Normal pubertal development in boys?

Answer 8

• Boys get growth spurt later

- Onset of testicular growth is about 13

Question 9

Early and delayed puberty in boys and girls

Answer 9

•Boys
–early < 9 years	(rare)
–delayed >14 (common, especially  CDGP)
•Girl
–early <8 years
–delayed >13 (rare)

Question 10

Delay of growth in puberty

Answer 10

• Mainly boys
• FH
• Bone age delay
• Need to exclude organic disease

Other

• Gonadal dysgenesis e.g. Turner 45X
• Chronic disease e.g. Crohn’s/ Asthma
• Impaired HPG axis e.g. Kallman’s syndrome
• Peripheral e.g. cryptoorchidism, Testicular irradiation

Question 11

What do you need to exclude in ambiguous genitalia?

Answer 11

Congenital adrenal hyperplasia

There is an adrenal crisis risk at 2 weeks of life

Question 12

Diabetes symptoms

Answer 12

• Thirsty
• Thinner
• Use toilet more
• Tired

Question 13

Approach to suspected case diabetes

Answer 13

• Finger prick capillary glucose test

- If result over 11mmol/l then call specialist team

Question 14

Red flags of DKA

Answer 14

• Nausea and vomiting
• Abdominal pain
• Sweet smelling breath
• Drowsiness
• Rapid, deep “ sighing” respiration
• Coma

Question 15

Main causes for obesity?

Answer 15

• Simple obesity
• Drugs
• Syndromes
• Endocrine disorders
• Hypothalamic damage

Question 16

What is an abnormal presentation in obesity?

Answer 16

SHORT + OBESE

Question 17

Treatment for obesity?

Answer 17

• Diet
• Exercise
• Psychological imput
• Drugs- not much use

Question 18

When to suspect Acquired hypothyroidism in children

Answer 18

–Lack of height gain
–Pubertal delay (or precocity)
–Poor school performance (but work steadily)

Question 19

Manifestations of early sexual development?

Answer 19

Breast development

• Infantile thelarche
• Central precocious development

Sexual secondary characteristics ( sex steroid, hormone secretion)

• Exaggerated adrenarche
• Precocious pseudo puberty a.k.a congenital adrenal hyperplasia

PV bleeding: premature menarche

Question 20

Presentation of central precocious puberty

Answer 20

• Growth spurt
• Advanced bone age
• Pubertal development
• Abnormal sex steroid secretion

Question 21

What do you need to exclude in central precocious puberty?

Answer 21

• congenital adrenal hyperplasia

- pituitary lesion– MRI