Evaluation of Worrisome Growth Flashcards
1
Q
Worrisome growth: definition
A
Can be worrisome along two variables:
- Height
- Short stature: height below -2 SD for age and gender OR height more than 2 SD below the midparental target height
- Dwarfism: height below -3 SD for age
- Midget: dwarf with normal body proportions
- Growth velocity
- Abnormally slow linear growth velocity or dropping across two major centile lines on growth chart
2
Q
Causes of short stature
A
- Normal
- Constitutional short stature
- Familial short stature
- Pathological
- Nutritional
- Endocrine
- Chromosome defects
- Skeletal dysplasias
- IUGR/SGA
- Metabolic
- Chronic diseases
- Psychosocial deprivation
- Drugs
3
Q
Nutritional causes of short stature
A
- Zinc, iron deficiency
- Anorexia
- IBD, celiac disease, CF
4
Q
Endocrine causes of short stature
A
- Hypothyroid
- Growth hormone deficiency
- Cushing’s disease
- Rickets
5
Q
Causes of short stature: chromosome defects
A
- Turner syndrome
- Down syndrome
- Prader-Willi syndrome
6
Q
Drugs causing short stature
A
- Glucocorticoids
- Stimulants
7
Q
Constitutional growth delay
A
- Growth deceleration during first 2 years of life
- Normal growth paralleling lower percentile curve throughout prepubertal years
- Delayed skeletal maturation and fusion of growth plates
- Catch-up growth achieved by late puberty
- End up along lower end of normal height range for family
- Polygenic trait - positive family in 60-80%
- Genetic defects unclear
- Reassurance of normal growth pattern
8
Q
Constitutional growth delay: treatment
A
- Boys:
- Testosterone if bone age >/= 11.5 years to avoid compromising final height
- Girls:
- Estrogen (not as common)
9
Q
Familial short stature
A
- Children with normal growth velocity & height within normal limits for parents’ heights
- Initially have decrease in growth rate between 6-18 months of age
- Some families may have tubular bone alterations
- Brachydactyly syndromes, SHOX haploinsufficiencies
10
Q
Failure to thrive
A
- Infants or young children with:
- Deceleration of weight gain to a point < 3%
- Fall in weight across two or more major percentiles
- Non-organic causes most common
- Poor nutrition
- Psychosocial factors
- May look like constitutional growth delay
11
Q
Nutritional growth retardation
A
- Linear growth stunting from poor weight gain in children > 2 years of age
- May be 2/2 systemic illnesses
- Celiac disease, IBD
- May be 2/2 stimulant medications
- Sometimes hard to distinguish from constitutional growth delay, constitutional thinness
12
Q
Hormonal causes of worrisome growth
A
- Generally, weight is spared
- Hypothyroidism
- Growth hormone/IGF-1 abnormalities
- Cushing’s syndrome
- Rickets
13
Q
Hypothyroidism
A
- Can result in profound growth failure
- Many clinical features seen in hypothyroid adults are lacking in children
- Primary hypothyroidism:
- Increased TSH, low T4
- Central hypothyroidism
- Normal TSH, low T4
14
Q
Growth hormone
A
- AP hormone
- Main function to promote linear growth
- Also affects body composition
- Increases lean body mass, decreases fat
15
Q
Growth hormone deficiency
A
- Absent/inadequate production of growth hormone
- Continuum - range of GH levels seen
- May be associated with deficiencies in other pituitary hormones
- Abnormal growth velocity with exclusion of other causes
21
Q
Turner Syndrome
A
- Most common sex chromosome abnormality of females
- Affects ~3% of female concepti
- Caused by complete or partial absence of 1 of X chromosomes
- Occurs in approximately 1/2000 live-born females
- Virtually all affected exhibit short stature
- Final height if untreated: about 20cm less than target height
- Haploinsufficiency of SHOX genes responsible for skeletal and growth abnormalities
- Generally not GH deficient but GH therapy improves growth and final adult height - start treatment early
