Endocrine Cases - Ferrill Flashcards
In Utero, infant size really depends on maternal factors such as: (4)
- Size,
- nutrition,
- health,
- social habits (ETOH, tobacco, stress, etc)
After birth, a child’s growth depends a lot more on?
Genetics - Normal growth is the result of the proper interaction of genetic, nutritional, metabolic, and endocrine factors
The first 18 months: Catch-up or catch-down growth
Kids will grow in an upward trend on the chart, but may change percentile lines until they reach their genetically predetermined level of growth velocity
After ______, kids typically stay along the same percentile of growth
18-24 months
Abnormal growth: Define Growth Failure
pathologic state of abnormally low growth rate over time, reflects a loss of two or more major percentile lines
Reasons for growth failure (3)
- Failure to thrive (environmental, dietary (celiac)),
- hormonal (growth hormone, thyroid),
- metabolic (storage disorders), etc.
Normal variants of growth?
- Short Stature
- Constitutional delay of growth and puberty
Three causes of short stature:
- idiopathic
- Familial
- Non-Familial
Define Idiopathic short stature
a condition characterized by a height more than 2 sd below average for age, or below the 2.5 percentile for age and gender
Define Familial Short Stature
short in comparison to age matched population, but consistent with familial genetics
Define non-familial short stature
short in comparison to both population and family
Define Constitutional delay of growth and puberty
temporary delay in the skeletal growth and thus height of a child with no other physical abnormalities causing the delay. These children ‘catch-up’ during mid-puberty
Types of Abnormal growth?
- growth failure
- excessive growth
Define excessive growth
kids either start out large for age, or at some point start to grow faster than expected for age.
How to tell the difference between constitutional delay or growth and constitutional short stature?
the Constitutional growth delay curve begins to angle upward during early to mid puberty to reach a higher percentile range. The Constitutional short stature curve never gets above the 3rd percentile.
Important History Elements
- Pregnancy and birth history
- Family History
- Previous Growth points
- general health of child
- ROS
- Social history
Things to learn with Pregnancy and birth history
- Problems in pregnancy (meds, infections, drugs, nutrition)
- Problems during birth
- Birth weight and length
- Gestation
Things to learn with Family History
- Parent’s height - Sex-adjusted mid-parental height is one way to determine if child is ‘on track’ genetically
- Timing of puberty in parents
Things to learn with Previous Growth point
- Observing growth velocity over time; Attention to patterns before and after 3 years old
If rate is:
- normal, likely normal variant
- Low or decelerating, growth failure likely present
- low initially, or slows just before puberty, then accelerates, likely CDGP
Things to learn with General health of child
Chronic disease or malnutrition
Things to learn in ROS
- General: Energy levels, sleep patterns, diet/nutritional intake
- Neuro: Headaches, visual changes, weakness,
- GI: vomiting, abdominal pain, diarrhea, constipation
- GU: sexual maturation, polyuria, polydipsia, oliguria
- MSK: multiple fractures, injuries, deformations
Things to learn in Social History
Home and school situations, stressors, social habits (tobacco, ETOH, etc.)
PE elements: signs of Turner syndrome
webbed neck, low set ears, broad chest
PE elements signs: of Noonan
webbed neck, double curve scoliosis and rib deformities
