Endo: Worrisome Growth 1 Flashcards
Compare how we measure kids’ height if less than 2 yo and how we measure kids’ height if over 20 yo
- Less than 2 yo: measure lying down
- Over 2 yo: measure standing up
*This may produce a seeming decrease in height at 2 yo, b/c little kids can’t stand up straight
Define short stature (3)
- Height that is more than 2 SD below mean
- Height that is 3rd percentile or less
- Height that is more than 3.5 inches below midparental target height
How do you calculate midparental height?
What is a child’s expected height?
Midparental height = [Mom height + Dad height +/- 5]/2
*Add 5 for son, Minus 5 for daughter
Expected height is midparental height +/- 3.5 inches
Define abnormal growth velocity on a growth chart
Abnormal growth velocity = crossing two major centile lines on the growth chart
Normal growth velocity typically indicates that there is _______________
Normal growth velocity typically indicates that there is no pathology
How do we determine skeletal maturation/age?
What does this tell us?
- Assessed via L hand xray
- Skeletal age indicates the time until growth plate (epiphyseal) closure
How does puberty onset correlate with bone age?
- Delayed onset puberty -> younger bone age
- Early onset puberty -> older bone age
Define Familial Short Stature
Children who are short, but have normal growth velocity and height is within normal for parents’ heights
Are kids with familial short stature born small or normal?
How does their growth progress over time?
Familial short stature
- Birth weight/length is normal
- Decrease in growth rate occurs btwn 6-18 mos
What is a colloquial term for constitutional growth delay?
Describe the growth over time.
CGD = “late bloomer”
- Growth deceleration occurs during first 2 years of life
- Then, normal growth velocity along lower percentile curve
- Bone age will be delayed here
- Then, late puberty and growth spurt
Describe the tx of constitutional growth delay (2)
- Reassurance
- Can give short course of testosterone to boys if bone age is over 11.5 yo
- Does not affect final height, but gives a burst
A growth chart shows weight plateauing before height.
Most likely cause?
If weight plateaus before height, it’s more likely a nutritional/GI issue
Define Nutritional Growth Retardation
Linear growth stunting due to poor weight gain in children over 2 yo
A growth chart shows plateauing height with normal or elevated weight.
What is the most likely cause? (system)
Endocrine problems cause height to be affected first
T4 and TSH in Central Hypothyroidism
- Low T4
- Inappropriately normal TSH
What would indicate that the short stature is reversible?
Low bone age
(eg. bone age of 8 yo, chronological age of 12 yo)
Are endocrine causes of growth delay generally reversible or irreversible?
Reversible
Describe the effect of GH on height and body composition
GH
- Promotes linear growth
- Increases muscle
- Decreases fat
What is unique about GH deficiency compared to deficiency of other pituitary hormones?
GH can be an isolated deficiency, whereas most other pituitary hormones deficiencies don’t occur alone
4 Signs of GH Deficiency
- Decreased muscle, increased truncal fat
- Small penis
- Large forehead with small face (skull keeps growing)
- Hypoglycemia as a newborn
How do we evaluate GH Deficiency (3)?
- IGF-1 level
- Bone age
- Stimulation testing
- clonidine, arginine, glucagon, L-dopa
Define Turner Syndrome
Complete or partial absence of 1 of the X chromosomes (45 XO)
*Only occurs in girls
What causes short stature in Turner’s?
Haploinsuffiency of SHOX (Short Height karyotype) gene
Describe the growth pattern and bone age of Turner’s syndrome
- 2 growth plateaus (one before 2 yo, one around 6 yo)
- Bone age is decreased but not very much (not fully reversible)
