Growth

Question 1

What are the DDx of short stature?

Answer 1

Physiological: genetic short stature, constitutional delay of growth & pubertyl

Pathological

• Proportionate: syndromic (Turner, Down), SGA, chronic illness (CHD, CF, asthma, IBD, celiac, CKD, JIA, thalassemia, anemia, hypothyroidism, Cushing, GH deficiency, malnutrition)
• Disproportionate: rickets, skeletal dysplasia

Question 2

What is the difference between rickets & osteomalacia?

Answer 2

Rickets: failure of mineralization of growing bone
Osteomalacia: mature bone

Question 3

What are the types of rickets?

Answer 3

Vitamin D-related: deficiency, Vit D dependent rickets
Non-vitamin D-related: hypocalcemia, hypophosphatemia
Secondary: tumour-induced osteomalacia

Question 4

What is short stature?

Answer 4

Height below 3rd percentile

Question 5

What history would you take for short stature?

Answer 5

Growth arrest (2y)
Prenatal: IUGR, inf, S/D
Natal: birth weight, length
Postnatal: illness, CKD, CNS irradiation
Growth data
Puberty: started or not
FH: short stature, growth delay, menarche, parental height
SH

Question 6

What PE would you perform for short stature?

Answer 6

Dysmorphic features
Midline defects
Visual field defect
Measurement: height, weight, arm span, U:L ratio
Hypothyroidism
Systemic exam
Puberty: M (pubic hair/penis stage, testicular vol), F (pubic hair/breast stage, menarche)

Question 7

How would you investigate short stature?

Answer 7

Remeasure height in 6m
Bone age
CBC: anemia
Urinalysis, RFT: CKD
CaPO4, ALP: rickets
Endocrine: TFT, IGF-1, sex hormone
Karyotype & FSH for girls (Turner)
MRI for neuro sx

Question 8

What are the indications for GH replacement?

Answer 8

Turner, CKD, SGA w/ failed catch-up growth

Question 9

How would you manage rickets?

Answer 9

Food: oily fish, calcium fortified milk, egg yolk

Sun exposure, vit D3, monitor ALP

Question 10

How would you manage Turner?

Answer 10

Short stature: recombinant GH
Delayed puberty: estrogen for 2y (secondary sexual characteristics) then add cyclic progesterone (prevent endometrial hyperplasia)
Reproduction: counselling