PAEDIATRIC ENDOCRINOLOGY

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PAEDIATRIC ENDOCRINOLOGY

• DR NOMAN AHMADCORK UNIVERSITY HOSPITAL

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Presentation Outline

• Paediatric endocrinology scope
• Physiology of endocrine system
• Normal growth
• Prerequisites
• Parameters
• Short stature evaluation
• Congenital hypothyroidism
• Congenital Adrenal Hyperplasia

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Paediatric Endocrinology Scope

• Regulation of normal growth
• Maintenance of body metabolism
• Stress management
• Fluid and electrolyte balance
• Bone mineral homeostasis
• Sex differentiation
• Puberty
• Glucose metabolism

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Pituitary Gland
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Pituitary Gland
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Pituitary Gland
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Hypothalamic-Pituitary GH-IGF1 Axis
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Growth Hormone Secretion
IGF1
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Hypothalamic-Pituitary-Thyroid Axis

• TSH

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Hypothalamic-Pituitary Adrenal Axis
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Cortisol Production
8.00 AM Cortisol Or ACTH stimulation test
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Renin-Angiotensin-Aldosterone
ELECTROLYTES BLOOD PRESSURE
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Hypothalamic-Pituitary Gonadal Axis

• LH FSH
• GnRH Stimulation

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Bone Mineral Metabolism
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Glucose Metabolism

• Insulin
• Glucagon
• Growth hormone
• Glucocorticoids
• Catecholamines

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Normal GrowthAndEvaluation of Short Stature
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Normal Growth
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Normal Growth
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Normal Growth
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Normal Growth

• Growth represents general health of a child
• Growth is analysed with
• Percentile
• SDS
• Height velocity
• Weight for height
• Mid parental height

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What does a child need to grow?

• Food (money)
• Hormones
• Good genes
• A good start (intrauterine)
• Good general health
• Love

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Important Growth Factors

• Prenatal
• Insulin
• IGF-1 and IGF-2
• Postnatal
• Growth hormone and IGF-1
• Thyroxin
• Puberty
• Gonadal hormones

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Constitutional Delay in Growth and Adolescence
(CDGA)

• Late bloomers
• Slowing in growth and weight in first 3 years
• Normal growth rate
• Delayed bone age
• Positive family history
• Normal final height
• Common in boys
• Benefit with gonadal steroids

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Familial Short Stature

• Normal intrauterine growth
• Linear growth cross percentiles downward in first
  2 years or during puberty
• Bone age is not delayed
• Final height is short and consistent with mid
  parental height or family history

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Pathological Short Stature

• Absolute height lt 3rd percentile
• Abnormal height velocity
• Height SDS -gt2.5 SDS
• Weight to height relationship
• Upper lower segment ratio
• Arm span(gt 6 cm)
• Mid parental height

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Measurements
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Mid Parental Height

• Target Height is MPH 10 cm
• Boys
• Father Ht. Mother Ht. 13
• 2
• Girls
• Father Ht. Mother Ht 13
• 2

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Upper to lower segment ratio

• Lower segment upper end of symphysis pubis to
  floor
• Upper segment Height LS
• U/L decline from birth to puberty
• Slight increase at puberty
• Precocious puberty inc. U/L
• Delayed puberty dec. U/L

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Upper to lower segment ratio
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Measurements

• Weight
• BMI
• Growth Velocity
• Arm span

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Causes of Short Stature

• Genetic
• IUGR or SGA
• Chromosomal
• Nutritional
• Chronic Illness
• Endocrine
• Bone Dysplasia

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Causes of Short Stature

• Short and obese
• Hormone deficiency
• Syndrome
• Short and thin
• Constitutional
• Malnutrition
• Systemic disease
• Tall and obese
• Exogenous obesity

BMI
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Endocrine Causes

• Growth hormone deficiency or resistance
• Hypothyroidism
• Cushing syndrome
• Precocious puberty

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Diagnostic Evaluation

• FBC
• Electrolytes
• ESR
• BUN, creatinine
• Bone profile
• LFT
• Glucose
• Coeliac screen
• Urinalysis

• Bone age
• IGF-1
• Free T4 and TSH
• Growth hormone
• 24 hrs. urinary cortisol
• Dexamethasone suppression test
• Karyotype

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Congenital Hypothyroidism
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Congenital Hypothyroidism

• 12000 to 14000 live births
• FM 21
• Most common treatable cause of mental retardation
• Thyroid dysgenesis
• Ectopy (2/3), hypoplasia, agenesis
• Hormone dysgenesis
• TSH (heel prick)
• Isotope scan

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Isotope Scan
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Congenital Adrenal Hyperplasia

• CAH is disorder of adrenal cortex
• 21 hydroxylase deficiency
• Cortisol deficiency
• Aldosterone deficiency
• Androgen excess
• Girls present with virilization
• Boys present with salt losing crisis

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Congenital Adrenal Hyperplasia
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