Evaluation of Worrisome Growth

Question 1

Age 0-3 years, which should you use, WHO or CDC growth chart?

Answer 1

WHO (international)

- breast fed infants

Question 2

Ages that we measure childrens high

Answer 2

age:
birth
2-4 days
1,2,4,6,9,12,15,18,24 months
Every year after through age 21

Question 3

Genetic potential

Answer 3

Boys:
(Mothers Height + 5in (13cm) + Fathers Height ) / 2

Girl:
(Fathers Height + 5in (13cm) + Mothers Height ) / 2

Question 4

When are height predictions not accurate?

Answer 4

In children with growth disorders

Children with different pubertal tempo

Question 5

Constitutional growth delay

Answer 5

characterized by growth deceleration during first 2 years of life followed by:
nl growth paralleling lower percentile curve throughout prepubertal years

Question 6

What bone age do boys need to be in order to give testosterone to help jump start their growth without compromising final height

Answer 6

> 11

females can get estrogen, but not as common

Question 7

Failure to thrive

- cause

Answer 7

Infants + toddlers with:

Deceleration of weight gain to
a point less than 3%
fall in weight across 2/more major percentiles

Non organic causes most common - poor nutrition + psychosocial factors

Question 8

Do most healthy infants born Small for Gestational Age (SGA) catch up in height?

Answer 8

Yes by age 2

• most catch up is achieved w/in 6 mo
• 10-15% born SGA remain short as adults
• FDA approved GH for SGA children who failed to catch up by age 2

Question 9

Hypothesis of SGA

Answer 9

Fetal response to prolonged nutrional deficiencies late in gestation may be prematuerly reset to a slow growth rate with a degree of resistance to GH, IGF-1, and insulin

Question 10

Hormonal causes of worrisome growth

Answer 10

Weight is spared
all have potential for growth. Not gen. disease.

1. Hypothyroidism
   - low metab.
2. GH/IGF-1 abnormalities
3. Cushing syndrome
   - increase acth –> BIG FIB
4. Rickets
   - lack ca2+ essential nutrient esp in adolescents

Question 11

Primary hypothyroidism vs Central hypothyroidism

test levels to expect

Answer 11

Straightforward:
Increased TSH,
Low T4

Central:
nl TSH
Low T4

Question 12

Fxns of GH

• main
• ancililary

Answer 12

Main:
Promote linear growth

Other: affects body comp

• Increase lean body mass
• Decreases fat

Question 13

Common CNS tumors associated with GH deficiency

Answer 13

Craniopharyngioma, germinoma

Question 14

Why cant you just screen GH levels? What can you check instead?

Answer 14

GH is secreted in pulses
- Released at night

Check IGF-1 instead

• GH status marker
• IGF-1 also affected by nutrition status (be careful)

Question 15

Syndromic short stature

Answer 15

1. Skeletal dysplasias (+ other genetic synd.)
2. Turner syndrome: haploinsufficiency of SHOX gene
3. Prader willi syndrome: GH deficient
4. Noonan syndrome: abnl GH post receptor signaling

Question 16

Most common sec ch. abnormality of females

Answer 16

Turner syndrome

• ave height is 4’8 inches
• caused by complete/partial absence of 1 of X ch.
• haploinsufficiency of SHOX gene

Question 17

Skeletal abnormalities of turner syndrome

Answer 17

1. short stature
2. increased carrying angle (arm wont come straight down due to abnorm. in radius+ulna)
3. Short neck
4. Micro/retrognathia

Question 18

Lymphatic obstruction signs of Turner syndrome

Answer 18

Low hairline
Webbed neck
Lymphedema

Question 19

Side effects of GH

Answer 19

1. slipped capital femoral epiphysis
2. Pseudo tumor cerebri
3. Long term risk