Paeds Vivas · endocrinology-diabetes-and-growth
Hypopituitarism and pituitary lesions — branching viva
Branching viva from a child with short stature and a falling height velocity, through the order of hormone loss, the dynamic tests that confirm each axis, the imaging of a suprasellar lesion and the germ-cell markers for a thickened stalk, to the safe replacement order and the neonatal presentation of congenital hypopituitarism.
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RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in the endocrine clinic and on the ward. The consultant asks you to work through three children: a nine-year-old with short stature and a falling height velocity, a six-year-old with new polyuria and a thickened pituitary stalk on MRI, and a term newborn with hypoglycaemia and a micropenis. The examiner releases information in stages.
Station opening
The consultant presents a 9-year-old boy whose height has crossed from the fiftieth to below the third percentile over three years, with a low height velocity and immature facial features. The examiner asks: "How would you interpret this growth pattern, and what does a falling height velocity tell you?" [1]
References6ShowHide
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- [5]Müller HL; Merchant TE; Warmuth-Metz M; et al Craniopharyngioma. Nat Rev Dis Primers, 2019.PMID 31699993
- [6]Liu AP; Takami H; Abdelbaki MS; et al Germinoma: Presentation, Management, and Recent Advances. Adv Cancer Res, 2025.PMID 41198339
- [7]Grimberg A; DiVall SA; Polychronakos C; et al Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency. Horm Res Paediatr, 2016.PMID 27884013
- [10]Fleseriu M; Hashim IA; Karavitaki N; et al Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2016.PMID 27736313
- [11]Di Iorgi N; Napoli F; Allegri AE; et al Diabetes insipidus--diagnosis and management. Horm Res Paediatr, 2012.PMID 22433947