This document discusses various endocrine disorders that can cause short stature in children, including hypothyroidism, Cushing's syndrome, and delayed puberty. It provides details on symptoms, causes, diagnostic tests, and treatment options for each condition. The document also covers other endocrine-related topics such as acromegaly, diabetes insipidus, juvenile diabetes, goiter, hypo- and hyperparathyroidism. Management involves addressing the underlying endocrine abnormality through medications, hormone replacement, and surgery when necessary.
4. A child is diagnosed to have a short
stature when his/ her height is less
than 3rd percentile of the normal
for age or more than 2 standard
deviation below the mean height
for that age, with a height velocity
usually less than the 25th%centile
for that age.
5. Endocrine causes like- hypothyroidism,
hypopitutarism, diabetes mellitus, crushing's
syndrome
Most common cause for short stature in India is
Protein energy malnutrition
Familiar genetic history
Delay growth and puberty
Skeletal dysplasia
Rickets
IUGR
Intrauterine infections
Teratogens- tobacco, alcoholism drugs
Chromosomal anomalies- down syndrome
6. Supine length is measure by an infantometer in
infants and children less than 2 years
Standing height is measured by stadiometer in
older children
In addition to height, measurement of weight
mid arm circumference, skin fold thickness and
head circumference
Upper segment ratio : lower segment ratio, this
proportion varies with age.
Usually US:LS ratio is approximately 1:7 at birth, 1:3
at 3 years, 1:1 by 3 years.
An abnormal US:LS ratio or span height indicated
short stature.
7.
8. clinical history: the time of onset of short stature
has great relevance in the differential diagnosis.
Physical examination: presence of characteristic,
physical sign of specific endocrine disease.
Lab investigations:
Estimation of bone age
Hematological tests: hb, hematocrit, total
differential blood count, blood cell morphology
and ESR.
Urine analysis
Stool examination
9. Height weight should be recorded frequently
Counseling of the child and the family is
essential
Important regular follow-up, monitoring of
therapy should be stressed
Lim lengthening surgery is being offered in
case of skeletal dysplasia
Replacement of sodium thyroxine in case of
hypothyroidism
Low dose estrogens are helpful for girls with
delayed puberty
11. It is the excess secretion of growth hormone
in children by the anterior lobe of the pitutary
gland, results in somatic overgrowth or
gigantism.
When hyepersecretion of the hormone occurs
after the fusion of skeletal epiphyses, it
causes acromegaly.
12. The child is taller than his/ her peers.
Peripheral parts of the body like- hands, feet,
mandible are large
Head circumference is increased
Features are coarse with prominent jaw, thick
skin and subcutaneous tissue with dorsal
kyphosis, enlarge tongue, bushy eyebrows.
Muscle weakness, bony cartilaginous
overgrowth, cardiomyopathies and
pigmentation of skin is present
Diffused nodular goiter or hyperthyroidism
may be present
13.
14.
15. Growth assessment
Clinical examination
X- rays
Ct scan and MRI
GH levels are elevated
16. Partial or complete resection of pituitary
gland
Conventional or high voltage radiography
Implanting radioactive isotopes
Bromocriptine, adopamine administered
16-20mg/day in case of acromegaly
17. It is a disease caused by the deficiency of antidiuretic
hormone which is secreted by the posterior pituitary
gland.
It may be also due to nephrogenic disturbanceof H2o
excretion in children.
18. Polydypsia
Polyuria
Urine with low specific gravity
Children may have fever, dehydration,weight
loss,&constipation.
19. Due to the causative factors
There is inability of the kidney to respond to ADH &
psychogenic form of polydipsia associated with
polyuria due to compulsive water drinking.
Diabetes insipidus with diabetes mellitus, optic
atrophy and deafness is known as wolform syndrome.
Diffusion of the distal tubules and collecting ducts is
reduced due to lack of ADH hormone.
20. Polyuria & polydipsia should be confirmed by
24 hours intake and output records.
• Urine specific gravity and osmolity test
• Vasopressin sensitivity test (VST)
• CT MRI scans may reveal lesion at
posterior pituitary gland.
21. Neurogenic diabetes insipidus can be
treated by administration of
desmopressin
Administer pitressin, I.M. or prescribed.
Analog of ADH given as a nasal spray, or
sublingual tablets for vasopressin.
Oral admionistration of chlorothiazide 20
mg/kg/24 hrs. in 2 divided doses.
Provide chlorothiazide foe nephrogenic
disorders.
22. Maintain fliud and electrolyte balance
Restriction of protein and salts
Emotional support
Parentral education
24. Childhood diabetes mellitus is a hereditary
disorder.
It is also known as Juvenile Diabetes Mellitus
Protein and fat metabolism will leads to raised
serum glucose levels also in urine
25. It is very commonest endocrinal disorder
of childhood and adolescence
According to WHO report in India about
40,000 infants and children are suffering
with this disease.
Onset is mostly before 15 years of age.
26. Predisposing factors include deficiency
of insulin, hereditary, obesity and
correlated endocrine factors
Pancreas produces inadequate amount
of insulin, proper oxidation of glucose will
not occur
Proteins and fats are oxidized at
abnormal rates
This leads to raised glucose levels
27. Rapid onset, major symptoms include –
Polyurea
Polydipsea
Polyphagia
Loss of weight
Tiredness etc..
Minor symptoms-
Skin and urinary tract infections
Dry skin
Red lips
Diabetes acidosis
28. Drowsiness
Dry skin
Tachycardia
Nausea
Abdominal pain
Extreme Hyperapnoea
Rapid and weak pulse
Decreased blood pressure
Decreased body temperature
Sunken ayes
Real failure
Diabetic coma
29.
30. Assess the general condition of the patient
Regular monitoring of glucose levels
Maintain IV therapy
IV sodium bicarbonate and potassium supplement
may be required
IV glucose if patient becomes hypoglycemic
NG intubation may be required to relieve abdominal
distention
Regular monitoring of urine for glucose and
acetones
Encourage exercises within normal limits to help in
reduction of glucose levels
Explain parents and patient about immediate care
of wound, dental check-up and dental; care
Parent and child should be taught about
administration of insulin, correct dose
32. It is a condition in which thyroxin hormones
levels are decreased.
It may be of two types-
Congenital
Acquired
The congenital hypothyroidism is a common
type may be associated with down syndrome
Acquired thyroidism occurs after the age of 1
year
33. Congenital hypothyroidism causes due to
gene mutations, failure of CNS and iodine
deficiency
Acquired may develop due to thyroid
dysfunction, deficiency of TSH
Exposure to thyroid drugs
34. World wide prevelance of
hypothyroidism is nearly 1-4000 new
baorns.
35. Children with congenital hypothyroidism may
have-
Thickened protruded tongue, thick lip
Anemia
Rough and thick skin
Over sleeping
Cool extremities
Wide posterior fontanel
Difficulty in feeding
36.
37. Children with acquired hypothyroidism may
have-
Decreased appetite
Dry skin
Coarse hair
Depressed deep tendon reflexes
Constipation
Enlarged thyroid gland
Delayed bone age
Muscle weakness
Delayed puberty
Growth retardation
Short stature
38. X-ray for bone age
Screening of thyroid hormone
Examination of serum T3 and T4 levels
39. Normalize the levels of thyroid hormone
Monitor serum thyroid levels regularly
Growth monitoring during therapies
Educate the parents during therapy
Control of constipation, correction of
feeding problems, improvement in
appetite.
41. Enlarge of thyroid gland
Cause may be due to various factors like
genetics, autoimmune disease
Goiter can be congenital or acquired
Iodine deficiency is one of the widely
prevalent nutritional problem
The recommendation of daily allowance
of iodine is about 50 mg for infants about
70 to 120 mg for children.
42. Congenital goiter: results from failure of
organify iodide, associated with congenital
deafness, cretinism etc.. It is results by
ingestion o f anti-thyroid hormones during
pregnancy
Acquired Goiter: due to poor intake of
iodine in water and food. Common in
himalayan origin
43. There are two types- neurologic type &
myxedematous type.
Incase of neurological type of signs and
symptoms- mental retardation, deaf, mutism
Myxoedematous syndrome- growth
retardation, mental retardation, deafness
44.
45. Idodised poppy seeds injection- IM- prevents
goiter in further pregnancies
Thyroid treatment is required beyond pre-
school age, indicating an inability of thyroid
gland
Salt iodization
47. Hypoparathyroidism is a state of
decreased secretion or peripheral action
of parathyroid hormone or it is
characterized by absent or low values of
plasma parathyroid hormone
48. Signs and symptoms of most form of
hypoparathyroidism are attributed to-
Hypocalcemia
Hyperphosphatemia
Decreased plasma ionized calcium
Presence of neonatal tetany
Mild parasthesia
Numbness
Tingling sensation
Irritability
Impaired memory
Elevated CSF pressure
49. Provide psychological support to parents
Give health education related to disease and
its prevention
Cataracts are common consequences of
chronic hypocalcemia
Provide treatment according to symptoms
57. It is defined as the absence of any signs
of puberty in girls by the age of 13 or 14
years
58. Classification: it is of two types-
I. temporary:
Constitutional delayed in growth and puberty
Nutritional disorders
Chronic systemic diseases
Hormonal disturbances
ii. Permanent causes:
Congenital
Hormonal
Tumor
Surgery
trauma
59. Medical history
Family history- history of consanguinity,
delayed puberty
Childs bone age
Examination of serum gonadotrophin levels,
FSH, LH
Serum testosterone
Serum thyroxin
Pelvic ultrasonography to identify
development of uterus and ovary
60. Short term, low dose hormonal therapy with
testosterone and oestrogen for 3-6 months
In case of hypogonadism, requires long term
replacement therapy with monthly injections
of testosterone for boys and cyclic estrogen,
progesterone for girls
61. Reassurance of child and family that
there is nothing wrong and that puberty
though delayed will progress normally
Provide hormonal therapy and educate
on importance of hormonal therapy
63. Cushing syndrome has been described at all
ages groups including neonatal period and
infancy.
It is often due to the functioning of malignant
or benign tumor of the adrenal gland
64. Term Cushing syndrome disease is used to
indicate bilateral adrenal hyperplasia
secondary to excessive pituitary ACTH, often
from a basophilic pituitary adenoma. It can
also results from prolonged administration of
corticosteroids in child.
65.
66. Common clinical features includes-
Obesity with moon shaped face
Flushed cheeks
Double chin and buffalo hump
Thin extremities
Purplish striae on abdomen, hip and thighs
Hypertension
Diminished glucose tolerance
Demineralization of bones
Short stature
Acne
Deepening voice
Clitoral enlargement
67.
68. Elevated cortisol levels
Screening test to screen adrenal pathology
Estimation of plasma cortisol in morning
sample
Radiological evaluation shows retarded bone
age
Tumors can be localized in adrenal imaging
using ultrasound, CT scan and MRI etc.