Growth (5/19) Flashcards
What happens to children with constitutional delay?
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
What do we measure as a proxy for GH?
IGF-1-IGFBP-3
What are some processes that affect normal growth?
- GI diseases
- Small gestational age
- Systemic disorders
- Psychosocial deprivation
- Genetic disorders
- Endocrine disorders
What GI disease affect normal growth?
Malnut, malabsorption, inflamma bowel dis, celiac dis
Describe small gestational age’s effect on growth
Most SGA kids catch up height by age 2, but 10-15% do not
What systemic disorders affect normal growth?
-pulmonary, immunological, cardiac, hematological, medication related
What genetic disease affect normal growth?
- Turners
- Downs
- skeletal dysplasia etc
What endocrine disease affect normal growth?
- Hypothyroidism
- excessive steroids
- GH def
What are ways to conduct a growth eval?
- Bone age determination by xray
- Dental dev
- Blood analysis
Describe Xray results
Normal bone age and short for age=genetically short. Delayed bone age=constitutional delay or disease, advanced bone age=precocious puberty
What blood analysis do you do for growth?
- CBC
- ESR
- Celiac screen
- Chemistry
- Karyotype (girls)
- GFs
- TSH, free T4
What do you look at to diagnose GH def?
- 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
Boys vs girls in utero
-FSH and LH levels are high, males have higher androgen levels
Boys vs girls in infancy
No dif in androgen/estrogen levels between males and females because the hypothalamus is suppressed
Boys vs girls in puberty
-GnRH release results in sex steroid production. Males have more testosterone and females more estrogen
At what ages do we do a workup for abnomral pub?
Boys: 14
Girls: 13
What is precocious puberty?
Early puberty
What are the causes of precocious puberty?
Central: idiopathic, CNS pathology, hamartoma (abnormal cells)
Peripheral: ovarian cysts, McCune albright syndrome, exogenous hormones
What are some neonatal puberty issues?
Breast enlargement, galactorrhea, uterine bleeding, genitalia concerns
What are some infant puberty issues?
Breast dev (benign premature thelarche) Small phallus
What do androgens do in early pub dev?
Pubic hair, body odor, voice, acne, growth
What do estrogens do in early pub dev?
Breast dev, growth
What are the androgens?
DHEAS, androstenedione, testosterone
What age do african americans and caucasian get breasts?
Mean 8.9 (AA) mean 10 (C)
How do we treat precocous pub?
Lupron, histrelin implant, no luron, andrgeon blockers
What is congenital hypothyroidism?
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
