Growth and Stature

Question 1

What are the three phases of postnatal growth

Answer 1

The infantile phase
The childhood phase
The pubertal phase

Question 2

What are the characteristic features of infantile phase

Answer 2

Rapid but decelerating growth during he first 2 years of life

Question 3

What is the overall growth in the infantile phase

Answer 3

30-35cm

Question 4

What are the characteristic features of the childhood phase

Answer 4

Growth at a relatively constant velocity of 5-7cm per year

Question 5

What is the most significant endocrine factor for growth in the childhood phase

Answer 5

Growth hormone

Question 6

What is characteristic of the pubertal phase

Answer 6

a groth spurt of 8-14cm per year due to synergistic effects of increasing gonadal steroid and GH secretion

Question 7

What ceases first, spinal growth or limb growth

Answer 7

Limb growth

Question 8

What can be used to estimate a child’s adult height

Answer 8

The mid-parental height

Question 9

What is mid-parental height useful for

Answer 9

assessing genetic influences on height

Question 10

What is bone age a measure of

Answer 10

skeletal maturity

Question 11

How is bone age obtained

Answer 11

by assessing the appearance and shape of the bones of the hand and wrist from a radiograph

Question 12

What is short stature

Answer 12

defined as a height 2 standard deviation or more below the mean height for children of that gender and chronological age

Question 13

What are some causes of short stature

Answer 13

Low birth weight and illnesses in infancy
familial
constitutional delay of growth and puberty
endocrine abnormalities (thyroid disease, Cushing’s, vitamin D deficiency or resistance)
Dysmorphic syndromes associated with abnormal skeletal growth (Turner’s syndrome, Down’s syndrome, achondroplasia)
Chronic ilness, malnutrition
Psychosocial problems
Idiopathic

Question 14

What do children with familial short stature have

Answer 14

short parent(s) with a history of normal puberty

Question 15

Why does the height of the child begin to drift from the growth curve

Answer 15

The onset of pubertal growth spurt is delayed

Question 16

Describe the physical examination and biochemical investigations for constitutional delay of growth and puberty (CDGP)

Answer 16

Both are normal

Question 17

What happens to the growth velocity for children with abnormalities in the endocrine control

Answer 17

Reduced growth velocity and they are usually overweight for their height

Question 18

What is the most common endocrine cause of short stature

Answer 18

GH deficiency

Question 19

What might GH deficiency be associated with

Answer 19

other pituitary hormone deficiencies

Question 20

What does GH stimulate in children

Answer 20

Epiphyseal prechondrocyte differentiation and linear bone growth in children
Gh also stimulates skeletal growth through stimulation of the hepatic synthesis and secretion of insulin-like growth factor-1

Question 21

What is linked to Cushing’s syndrome in children

Answer 21

Glucocorticoid therapy for asthma, IBD or immunological renal disease

Question 22

During a clinical examination, what should be looked for

Answer 22

Reduced growth velocity 
Underweight/ overweight 
pubertal development 
Dysmorphic features 
Features of chronic illness
Features of endocrine abnormalities

Question 23

If a child is found to be hypothyroid, what should be postponed until thyroxine has been adequately replaced

Answer 23

testing of GH

Question 24

How is GH administered

Answer 24

daily subcut injections

Question 25

What are some adverse effects of GH injections

Answer 25

benign intracranial hypertension
carpal tunnel syndrome
pancreatitis
increase in growth and pigmentation of naevi

Question 26

What is the goal of GH deficiency

Answer 26

To achieve IGF-1 levels of about 1 standard deviation above the mean for age/ Tanner stage of pubertal development

Question 27

Describe the treatment in Turner’s syndrome

Answer 27

slightly higher doses of GH because they have a degree of GH resistance

Question 28

Describe the relationship between obesity and overall GH production

Answer 28

Obesity may be accompanied by an early onset of puberty and modest overgrowth
Obese children often have diminished overall GH production but high normal serum IGF-1 and GH binding proteins, resulting in tall stature for age prior to puberty

Question 29

If an oral glucose tolernce test is carried out, what will it show in children with GH secreting adenomas

Answer 29

failure of GH suppression in these children

Question 30

When is treatment encouraged for tall stature

Answer 30

extreme cases