CIS Peds Evaluation of short stature (Dow) Flashcards
how do you calculate expected (predicted) height for girls
Midparental height calculation
Girls: 13 cm (or 5 inches) is subtracted from the father’s height and averaged with the mother’s height.
how do you calculate expected (predicted) height for boys
Midparental height calculation
Boys: 13 cm (or 5 inches) is added to the mother’s height and averaged with the father’s height.
what is the single most important factor in evaluating growth of a child b/w age 2 and onset of puberty?
abnormal growth velocity
*pretty much any child should grow more than
4 cm/year, or about 2 in/year
delayed or advanced bone age is defined as what….
bone age that is 2 SD or more below or above the mean (approximately 20 percent below or above the chronological age) or about 2 years !
what is constitutional delay of growth and puberty
normal height for bone age, but not for chronological age
family history positive for delayed growth and/or puberty
H&P, bone age delayed
reassure and monitor growth for 6 months
consider treatment with steroids during puberty
slow height velocity early, then normal
pubertal growth spurt is delayed but prolonged–> normal adult height ***
what is the most common cause of growth failure worldwide
malnutrition
height is affected less than weight, but both are decreased
when you have an endocrine cause (Cushings, hypothyroid, GH deficiency) for poor growth, what happens to height and weight?
height is more affected
weight is not affected as much
so you have increased weight for height!
so you think they are fat short people!
what may be the only presenting signs of Turners syndrome
Answer *** short stature and/or delayed puberty –> 1 or the other or both
nOTE:
frequent otitis media or UTI? can also be seen in Turner syndrome
problems with nonverbal learning skills common
webbed neck, shield chest, wide spaced nipples, swollen feet, hyperpigmented nevi , increased carrying angle
Can also have Turner’s mosaic pattern…. partial Turner
short stature, sun-sensitive skin changes, increased risk of cancer
Bloom syndrome
what do abnormal body proportions and characteristics suggest
genetic condition
what is Madelung deformity
seen in Turner syndrome and Shox mutations
it is focal dysplasia of the distal radial physis leading to a prominent ulna and wrist pain
what do you do in screening for deficiencies in ENDO cases in peds
Bone age
CBC, ESR
electrolytes, creatinine
TSH, free T4
Tissue transglutaminase, IgA for celiac screen
IGF-1 and IGFBP-3 - screen for GH deficiency
karyotype (DON”T MISS IN TURNER) ***TQ
how does familial short stature look on a growth chart
just below 0% tile or 5th percentile but tracks perfectly and grows at normal rate-
parents are short most likely
height is falling off growth curve and is flattening MORE than the weight
endocrine cause
most likely GH deficiency
started out in 3rd to 5ht percentile for weight and now they are really low
5th percentile for height
environmental failure to thrive
not on growth curve in beginning but gets on it!
normal catch up growth pattern
intrauterine growth delay
13 year old male presents to the office with history of short stature. His mother states that he has been short since about the age of 6.
He has a normal birth history and grew normally until about age 5 or 6 and then seemed to stop growing normally. He was evaluated at a medical center in another area of the country and his mother states they told her he had a “growth hormone deficiency”.
His mother is an immigrant and speaks English poorly and does not understand his medical condition very well. She states that he only took the pills for a brief period of time and then stopped.
They recently moved into the local area. He has continued to grow poorly.
He is a B student in school and his only other complaint is dry skin
Body measurements: The adolescents is far below the first percentile for height but is above the 50th in weight. His blood pressure is 100/60 and his pulse at rest is 55.
Sexual maturity ratings: He is a SMR of 2 for both pubic hair and genital stage.
Physical examination: He appears to have dry skin and dry hair.
endocrine disorder - growth curve shows falling off in height but not weight
- short and round
- dry skin
- most likely hypothyroidism - check TSH and T4
