2: Endocrine - GH deficiency Flashcards

1
Q

What is the most common cause of growth hormone deficiency

A

Cranial radiation

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2
Q

What are two primary causes of GH deficiency

A
  • Congenital hypopituitarism

- Idiopathic

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3
Q

What are 4 secondary causes of GH deficiency

A
  • Cranial radiation
  • Craniopharyngioma
  • TBI
  • Psychosocial deprecation
  • Infiltration (eg. sarcoidosis)
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4
Q

What is Laron Syndrome

A

Individual is insensitive to GH, causing high GH and low IGF-1

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5
Q

What is the problem with Laron Syndrome

A

Individuals are unresponsive to exogenous GH

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6
Q

How does GH deficiency in infancy present

A
  • Prolonged jaundice
  • Hypoglycaemia
  • Normal growth
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7
Q

Why will GH deficiency in infancy not impact growth

A

As infants do not depend on GH from growth, use TH and environment

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8
Q

What are features of childhood GH deficiency

A

Short-stature

Decreased muscle mass - which is replaced with fat causing obesity

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9
Q

How will children with congenital GH deficiency present

A
  • Hypoplasia mid-facial bone
  • Frontal bone protrusion
  • Delayed dental eruption
  • Delayed closure anterior fontanelle
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10
Q

Where is GH released from

A

Anterior pituitary

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11
Q

Explain GH secretion

A

GH is released diurnally - majority release happening at night.

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12
Q

What causes negative feedback om GH secretion

A

GHRH - stimulates GH secretion

GHIH - inhibits GH secretion

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13
Q

When does GH influence growth

A

Childhood and Adolescence

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14
Q

What is the gold-standard investigation for GH deficiency

A

Insulin tolerance-test

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15
Q

Explain the insulin tolerance test

A

Insulin is injected and BG monitored frequently thereafter. Insulin should cause secretion of GH to maintain levels of glucose. Therefore profound hypoglycaemia indicates GH deficiency

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16
Q

What other provocation test is used to diagnose GH deficiency

A

24h serum GH measurements

17
Q

Explain NICE’s stance on diagnoses GH deficiency

A
  • GH deficiency is predominantly a clinical diagnosis

- In children with suspected deficiency, two confirmatory tests should be ordered

18
Q

Why is a bone x-ray obtained in GH deficiency

A

Determine skeletal maturity age

19
Q

Why may MRI be ordered in GH deficiency

A

Distinguish cranial lesions which could be causing GH deficiency

20
Q

How is GH deficiency managed

A

Recombinant GH is injected OD by SC Injection

21
Q

When is recombinant GH given until

A

Until individual reaches adult height