Growth

Question 1

How do you calculate genetic expectations of growth based on parents?

Answer 1

(M+F +/-5) / 2

Question 2

When is peak growth?

Answer 2

11. 5 years old for girls

13. 5 years old for boys

Question 3

Genetic expectations of height are based on…(3)

Answer 3

Mid parental height
Familial timing of puberty and growth
Ethnicity

Question 4

What is GH physiology?

Answer 4

GHRH from hypothalamus–>GH from anterior pituitary–>IGF-1 from liver–>Bone resorption and growth

Question 5

What categories impact normal growth? (6)

Answer 5

Endocrine disorders (hypothyroidism, excessive steroids, GH deficiency)
GI (malnutrition, malabsorption, IBD, celiac disease)
SGA/IUGR
Systemic disorders (pulm, immuno, cardiac, hematological, med-related)
Psychosocial deprivation: neglect due to lack of nurturing/nutrition
Genetic disorders (Turner, Down syndrome, skeletal dysplasia, chromosomal disorders, Prader-Willi, Noonan, SHOX defect)

Question 6

What is growth pattern of endocrine disorders?

Answer 6

Gain weight but grow slowly

Question 7

How do you evaluate growth via X-ray?

Answer 7

Look at bone age–>fusing…are they late bloomer or just short?

Question 8

What are things you look for in blood analysis?

Answer 8

CBC, ESR (Krohns?), celiac screen, chemistry, karyotype (for girls), growth factors (IGF1), TSH/free T4

Question 9

Diagnosis of GH Deficiency (6)

Answer 9

History of risk factors (midline defects, malformations)
Poor growth velocity, Delayed bone age
Low IGF1, Failed GH provocative testing (glucose)
MRI of pituitary/hypothalamus

Question 10

Growth Key Points

Answer 10

Growth reflects overall health
Anticipating growth patterns in a family
Peak growth rates in boys vs. girls
Tall/short stature is not due to GH
Poor growth vs. short stature
Features of Turner's
Workup for poor growth

Question 11

Neonatal puberty issues (4)

Answer 11

Breast enlargement
Galactorrhea
Uterine bleeding
Genitalia concerns

Question 12

Early Puberty Development: What are signs of androgens (4)

Answer 12

DHEA/Androstenedione/testosterone

Pubic hair
Body odor
Voice/acne
Growth surge

Question 13

Early puberty development: what are signs of estrogen? (2)

Answer 13

Breast development

Growth surge

Question 14

Onset of puberty: breast (consider race)

Answer 14

African American: 6% by age 6; mean by 8.9

Caucasian: 5% by age 7; mean by age 10

Question 15

Onset of puberty: menarche (racial difference)

Answer 15

A.A: 12.16

Caucasian: 12.88

Question 16

What are causes of precocious puberty?

Central (3) and peripheral (3)

Answer 16

Central precocity: idiopathic, CNS pathology, hamartoma

Peripheral: ovarian cysts, McCune-Albright, exogenous

Question 17

Treatment of Precocious Puberty (4)

Answer 17

Lupron: monthly injection to halt puberty
Histrelin: subQ arm implant
Androgen blockers/Androgen receptor inhibitors:

Question 18

Congenital hypothyroidism: Diagnosis and prognosis

Answer 18

Incidence=1/4000
Detected via state screening
Prognosis is excellent!

Question 19

Congenital hypothyroidism: treatment

Answer 19

Thyroxin