CIS Peds Evaluation of short stature (Dow)

Question 1

how do you calculate expected (predicted) height for girls

Midparental height calculation

Answer 1

Girls: 13 cm (or 5 inches) is subtracted from the father’s height and averaged with the mother’s height.

Question 2

how do you calculate expected (predicted) height for boys

Midparental height calculation

Answer 2

Boys: 13 cm (or 5 inches) is added to the mother’s height and averaged with the father’s height.

Question 3

what is the single most important factor in evaluating growth of a child b/w age 2 and onset of puberty?

Answer 3

abnormal growth velocity

*pretty much any child should grow more than
4 cm/year, or about 2 in/year

Question 4

delayed or advanced bone age is defined as what….

Answer 4

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 !

Question 5

what is constitutional delay of growth and puberty

Answer 5

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 ***

Question 6

what is the most common cause of growth failure worldwide

Answer 6

malnutrition

height is affected less than weight, but both are decreased

Question 7

when you have an endocrine cause (Cushings, hypothyroid, GH deficiency) for poor growth, what happens to height and weight?

Answer 7

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!

Question 8

what may be the only presenting signs of Turners syndrome

Answer 8

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

Question 9

short stature, sun-sensitive skin changes, increased risk of cancer

Answer 9

Bloom syndrome

Question 10

what do abnormal body proportions and characteristics suggest

Answer 10

genetic condition

Question 11

what is Madelung deformity

Answer 11

seen in Turner syndrome and Shox mutations

it is focal dysplasia of the distal radial physis leading to a prominent ulna and wrist pain

Question 12

what do you do in screening for deficiencies in ENDO cases in peds

Answer 12

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

Question 13

how does familial short stature look on a growth chart

Answer 13

just below 0% tile or 5th percentile but tracks perfectly and grows at normal rate-

parents are short most likely

Question 14

height is falling off growth curve and is flattening MORE than the weight

Answer 14

endocrine cause

most likely GH deficiency

Question 15

started out in 3rd to 5ht percentile for weight and now they are really low

5th percentile for height

Answer 15

environmental failure to thrive

Question 16

not on growth curve in beginning but gets on it!

Answer 16

normal catch up growth pattern

intrauterine growth delay

Question 17

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.

Answer 17

endocrine disorder - growth curve shows falling off in height but not weight

• short and round
• dry skin
• most likely hypothyroidism - check TSH and T4