Growth And Development

Question 0

During puberty, growth hormone increases, as well as…….name these growth factors and their synonym

Answer 0

Insulin-like growth factors one and two, or somatomedins.

Question 1

How long after onset of puberty does peak height velocity normally occur?

How much later does peak height velocity occur in boys than girls.

Answer 1

2.5 years

Two years.

Question 2

What is average peak height velocity for boys, and for girls

Answer 2

9 cm per year for girls, 10.3 cm per year for boys

Question 3

Formula to predict mid parental height:
One. Girls
Two. Boys

Answer 3

Girls: (father’s height -13 cm plus mother’s height)/2

Boys: (father’s height plus mothers height +13 cm) divided by two

Question 4

Name four conditions that may result in delayed bone age/maturation

Answer 4

Hypothyroidism, hypopituitarism, chronic illness, and constitutional delay. Turner syndrome may produce normal or delayed bone age.

Question 5

Definition of precocious puberty for girls (Caucasian, African-American)

Definition of precocious puberty for boys

Answer 5

Girls Caucasian-less than seven years of age, African-American less than six years of age

Boys: signs of puberty at less than nine years of age

Question 6

First event of puberty and girls:

Sequence of events in puberty-girls, with average length between events

Menarche usually occurs in what sexual maturity rating

Answer 6

Thelarche followed six months later by pubarche followed 18 months later by menarche

SMR four

Question 7

Average duration of puberty-boys

Average duration of puberty-girls

Answer 7

Three years

Four years

Question 8

What is the first event marking onset of puberty in boys?

Average age of onset of puberty in boys?

What are the next changes, marking next three stages of sexual maturity?

Answer 8

Testicular enlargement is the first event

Average age of onset is 11.5 years.

Stage two-testicular enlargement, slight reddening of scrotum
Stage three-penis begins to enlarge
Stage four - continued testicular enlargement, enlargement of scrotum and darkening, penis increases in length and breadth

Question 9

Differential diagnosis of short stature without pubertal delay? Most common cause?

Answer 9

Familial
Isolated growth hormone deficiency
IU GR
Hypothyroidism
Syndromic (Down, Newnan, hurler)
Skeletal disorders
HIV

Question 11

Describe a preliminary work up for short stature

Answer 11

Bone age, CBC, said rate, celiac screen, chemistry, karyotype for girls, and IGF-one, IGF BP-three growth factors, TSH, LH, FSH.

Question 12

In the setting of short stature or delayed puberty, what would an elevated FSH and LH indicate?

Answer 12

Primary gonadal problem

Question 13

Define delayed puberty for girls? Boys?

Answer 13

For girls, no breast development at age 13, no pubic hair after age 14, No menstruation after age 16

boys no testicular enlargement by age 14, No pubic hair after age 15

Question 15

List a differential diagnosis of primary hypogonadism

Answer 15

Chromosomal disorders like Turner, Noonan, and Klinefelter

Incological issues

Gonadal damage

Infections like mumps

Intersex disorders like testicular feminization

Question 16

With short stature, what does it mean when the weight is affected more than height?

Answer 16

Gastrointestinal diseases the primary consideration, as endocrine disease is unlikely. Consider also psychosocial disorders.

Question 17

Work up for delayed puberty

Answer 17

Bone age x-ray, CBC, ESR, chemistry, IGF-one IGF-BP three, prolactin

FSH, LH, estradiol, testosterone

Question 18

Low IGF-one suggests possibility of what deficiency?

Caution regarding interpretation of low IGF-I if what other finding?

Answer 18

Growth hormone deficiency, but caution in the setting of poor weight gain. Can be due to chronic illness such as G.I. disease

Question 19

What is the mean age for onset of puberty in girls (African-American, Caucasian)?

Answer 19

African-American 8.9 years

Caucasian 10 years

Question 20

Name tests to assess growth hormone deficiency

Answer 20

IGF-1 and IGF-BP-3

Glucagon stim test 1 mg results in a rise of growth hormone to greater than 7-10 ng/mL

Question 21

List three criteria for short stature (in other words, when would one be concerned regarding possible short stature)

Answer 21

1) linear growth rate less than 4-5 cm per year before the growth spurt OR
2) height greater then two standard deviation from the mid parental height
3) height greater than three standard deviation from the mean

Question 22

What is a GnRH stim test?how is it done?

What are the findings in primary gonadal failure? What are the findings in pituitary failure?

What are the findings in constitutional delay of puberty?

Answer 22

GnRH stimulation test determines if pituitary function is normal for degree of pubertal stage

Measure LH and FSH levels before and every 30 minutes for three hours after 100 µg GnRH

Primary gonadal failure-LH and FSH will increase normally. Pituitary failure-little increase. Constitutional delay of puberty-LH and FSH responses are small but consistent with bone age and pubertal stage

Question 23

Differential diagnosis of short stature with pubertal delay. What is the most common cause?

Answer 23

Constitutional delay (90-95%!)
Panhypopituitarism
Congenital syndromes like Turner
Hypogonadotrophic hypogonadism syndromes including Kallman (anosmia), PraderWlli
Glucocorticoid excess
Chronic illness and HIV

Question 24

Differential diagnosis of excessive growth-tall stature

Answer 24

1. Constitutional tall stature
2. Excessive growth hormone
3. Anabolic steroid xs (Adrenal tumor, congenital adrenal hyperplasia, precocious puberty)
4. Hyperthyroidism
5. Miscellaneous syndromes like Marfan, neurofibromatosis

Question 25

Average age of menarche (normal range).

How long after the start of the growth spurt is menarche expected?

During what sexual maturity rating stage is menarche expected?

Answer 25

Average age of menarche 12 years four months (range 9-16+)

Menarche expected 3.3 years after the start of growth spurt, 1.1 years after peak height velocity

SMR three and four.

Question 26

Percentage of body fat necessary for menarche and maintenance of menstruation

Answer 26

Approximately 20%. 17% for menarche, 22% for maintenance.

Question 27

Average age of menarche United States?
Two standard deviation range?
How long after Telarche (average)?

definition of primary amenorrhea

Answer 27

12.7 years
11-15

Two years.

No episodes of uterine bleeding by the age of 14-15 years with absent secondary sex characteristics, or no menstruation by age 16-16.5 regardless of secondary sex characteristics