Evaluation of Worrisome Growth Flashcards
3 height definitions worrisome growth
- short stature: below -2SD for age and gender or height more than 2SD below mid parental height target
- dwarfism: below -3SD for age
- Midget: dwarf with normal body proportions
worrisome growth velocity
abnormally slow linear growth velocity or dropping across two major gentile lines on the growth chart
genetic potential formula
Boys:
.5[mother’s height + 13cm(5in) + father’s height]
Girls:
.5[father’s height - 13cm(5in) + mother’s height]
The degree of skeletal maturation is directly correlated with what?
time of epiphyseal closure
body proportions at birth vs 10yearsold
upper to lower body ratio
birth: 1.7
10years: 1.0
Arm span boys vs girls
boys: shorter than height before 10-11 years; average adult male arm span 5.2cm>ht
girls: shorter than height before 10-14 years; average adult female arm span 1.2cm>ht
constitutional growth delay definition
growth deceleration during first 2 years of life followed by normal growth and paralleling lower percentile curve throughout prepubertal years
constitutional growth delay characteristics
- delayed skeletal maturation
- catch up growth during late puberty and delayed fusion of growth plates
- end result: lower end of normal height for families
- polygenic trait; positive family in about 60-80% of patients
treatment of growth delay characteristics
normal growth pattern
boys >11 with testosterone to avoid compromising final height
girls with estrogen
familial short stature
children have normal growth velocity and height wnl for parent’s height
initially will have decrease in growth rate between 6 and 18 mnths of age
some families may have tubular bone alterations: brachydactyl syndromes, SHOX haploinsufficiencies
failure to thrive
infants or young children with
1. deceleration of weight gain to a point
nutritional growth retardation
linear growth stunting from poor weight gain in children under 2years of age
may be secondary to systemic illnesses like celiac, iBD
stimulant medications
sometimes hard to distinguish from constitutional growth delay and constitutional thinness
small for gestational age (SGA)
less than -2SD for birth weight or length
etiologies:
- maternal: infection, nutritional deficiencies, uterine abnormalities, smoking, ETOH, drugs
- Placental: previa, abruption, infarcts, structural, multiple gestation
- fetal: chromosomal abnormalities, metabolic, infections, malformations
Catch up growth and final height in SGA
most healthy infants achieve catch up height by age 2 years; most of which is achieved within 6 months of birth
10-15% of children born SGA will remain short as adults
final height can also be compromised by early puberty
GH treatment in SGA children
SGA children who have catch up growth by 2 years
GH should not be given without appropriate nutritional intake
may increase final height by an average of 3 inches: -1.1–> -0.9 SD from -2.3 SDS
4 hormonal causes of worrisome growth
- hypothyroidism
- growth hormone/ IGF-1 abnormalities
- Cushing syndrome
- Rickets
hypothyroidism in children
profound growth failure
many clinical features seen in hypothyroid adults not seen in children
primary vs central hypothyroidism
primary: increased TSH, low T4
Central: low T4, normal TSH
growth hormone
anterior pituitary hormone
promotes linear growth
affects body composition to increase lean body mass and decreases fat
6 reasons for congenital growth hormone deficiency
- hypothalamic pituitary malformations
- holoprosencephaly/ schizencephaly
- isolated cleft lip or palate
- Septo-Optic Dysplasia: 50% have hypopituitarism
- Optic nerve hypoplasia
- Empty sella syndrome
5 reasons for acquired GH deficiency
- trauma
- CNS infection
- CNS tumors
- cranial irradiation
- hypophysitis
growth hormone deficiency on the graph
abnormal growth velocity with exclusion of other causes
7 GH Deficiencies signs
- decreased muscle build
- increased SubQ fat
- Immature face for age
- Prominent forehead, depressed midface
- small phallus in males
- other midline facial defects
- history of prolonged jaundice and or hypoglycemia in newborn period
growth hormone deficiency evaluation 3 parts
- bone age
- IGF-1 (IGFBP-3 in infant): however low in underweight children regardless of GH status
- Stimulation testing (never draw random GH level): clonidine, arginine, glucagon, l-dopa
4 syndromic short stature reasons
- skeletal dysplasias and other genetic syndromes
- turner: haploinsufficiency of SHOX genes
- Prader-Willi: GH deficient
- Noonan: abnormal GH post receptor signaling
turner syndrome stats
most common chromosome abnormality of females
~3% female concepti
complete of partial absence of 1 X chromosome
1/2000 live born females
turner syndrome height
final height is about 20cm less than target if untreated
haploinsufficiency of SHOX genes responsible for skeletal and growth abnormalities
turner syndrome height treatment
GH therapy improves growth and adult height despite the fact that they are usually not deficient
starting treatment early is important to offer best potential for growth
4 skeletal abnormalities in Turner Syndrome
- short
- increased carrying angle
- short neck
- micro or retinognathia
7 general abnormalities Turner syndrome
- cardiac abnormalities: bicuspid aortic valve, coarctation
- Renal: horseshoe kidney
- Ovarian insufficiency
- hypothyroidism/ celiac disease
- otitis media
- hearing loss
- non verbal learning disability
3 lymph obstruction in turner
- low hairline
- webbed neck
- lymphedema
3 categories to evaluate worrisome growth
- bone age: left hand and wrist
- screening labs: metabolic pannel, CBC, UA, karyotype in girls, TSH & T4 (IGF-1)
- Nutritional growth retardation: ESR, TTG, IgA
