Growth (5/19)

Question 1

What happens to children with constitutional delay?

Answer 1

Lag 2-4 years behind average for age and sex in ht, pubertal dev and bone age. USually a fam hx of the same. By mid to late teens, catch up and reach final height in normal range

-plateau in height and then rapidly grow

Question 2

What do we measure as a proxy for GH?

Answer 2

IGF-1-IGFBP-3

Question 3

What are some processes that affect normal growth?

Answer 3

• GI diseases
• Small gestational age
• Systemic disorders
• Psychosocial deprivation
• Genetic disorders
• Endocrine disorders

Question 4

What GI disease affect normal growth?

Answer 4

Malnut, malabsorption, inflamma bowel dis, celiac dis

Question 5

Describe small gestational age’s effect on growth

Answer 5

Most SGA kids catch up height by age 2, but 10-15% do not

Question 6

What systemic disorders affect normal growth?

Answer 6

-pulmonary, immunological, cardiac, hematological, medication related

Question 7

What genetic disease affect normal growth?

Answer 7

• Turners
• Downs
• skeletal dysplasia etc

Question 8

What endocrine disease affect normal growth?

Answer 8

• Hypothyroidism
• excessive steroids
• GH def

Question 9

What are ways to conduct a growth eval?

Answer 9

• Bone age determination by xray
• Dental dev
• Blood analysis

Question 10

Describe Xray results

Answer 10

Normal bone age and short for age=genetically short. Delayed bone age=constitutional delay or disease, advanced bone age=precocious puberty

Question 11

What blood analysis do you do for growth?

Answer 11

• CBC
• ESR
• Celiac screen
• Chemistry
• Karyotype (girls)
• GFs
• TSH, free T4

Question 12

What do you look at to diagnose GH def?

Answer 12

• Hx of risk factors (pit truama, tumor, genetcis etc)
• Poor growth velocity
• Delayed bone age
• Low IGF1, IGFBP-3
• Failed GH provocative testing
• MRI of pit/hypothalamus

Question 13

Boys vs girls in utero

Answer 13

-FSH and LH levels are high, males have higher androgen levels

Question 14

Boys vs girls in infancy

Answer 14

No dif in androgen/estrogen levels between males and females because the hypothalamus is suppressed

Question 15

Boys vs girls in puberty

Answer 15

-GnRH release results in sex steroid production. Males have more testosterone and females more estrogen

Question 16

At what ages do we do a workup for abnomral pub?

Answer 16

Boys: 14
Girls: 13

Question 17

What is precocious puberty?

Answer 17

Early puberty

Question 18

What are the causes of precocious puberty?

Answer 18

Central: idiopathic, CNS pathology, hamartoma (abnormal cells)

Peripheral: ovarian cysts, McCune albright syndrome, exogenous hormones

Question 19

What are some neonatal puberty issues?

Answer 19

Breast enlargement, galactorrhea, uterine bleeding, genitalia concerns

Question 20

What are some infant puberty issues?

Answer 20

Breast dev (benign premature thelarche)
Small phallus

Question 21

What do androgens do in early pub dev?

Answer 21

Pubic hair, body odor, voice, acne, growth

Question 22

What do estrogens do in early pub dev?

Answer 22

Breast dev, growth

Question 23

What are the androgens?

Answer 23

DHEAS, androstenedione, testosterone

Question 24

What age do african americans and caucasian get breasts?

Answer 24

Mean 8.9 (AA) mean 10 (C)

Question 25

How do we treat precocous pub?

Answer 25

Lupron, histrelin implant, no luron, andrgeon blockers

Question 26

What is congenital hypothyroidism?

Answer 26

Def in thyroid hormone present at birth that, if untreated, can lead to growth failure and permanent mental retardation. Seen in 1/4,000 births and now e have a newborn screening test. Excellent prognosis