ICR Growth Disorders Flashcards
When is the fastest growth rate for an individual?
During the intrauterine period. Growth velocity averages 68 cm/year during this time.
Normal growth is a result of the interaction between what?
Genetic, nutritional, environmental/social, metabolic and endocrine factors.
When is crossing percentiles considered to be abnormal?
After the first two years of life.
A child experiences growth failure when the growth rate is less than what?
5 cm/year
When does the slowest growth occur?
Just prior to puberty
How does the start of puberty usually manifest in a female? Male?
Breast development in females. Increase in testicular volume (TV) for males. TV measured by an orchidometer
What does PHV stand for?
Peak Height Velocity
What is the hormone responsible for fusion of growth plates in both men and women?
Estrogen. Estrogen potentiates GH secretion (age dependent) and IGF-1 axis. This is why there is a growth spurt in puberty
What are the most important factors for normal growth prenatally?
Insulin, nutrition (and placental function), and general genetic endowment of the child.
What does LGA stand for?
Large for gestational age
What two hormones, which do not have a significant effect on prenatal growth, are important for growth later in life?
Thyroxine and growth hormone
What three categories of medications can strongly affect growth development?
steroids (topical, nasal, inhaled or oral), amphetamines (ADHD), oncology medication and treatment (hypothalamus and pituitary are radiosensitive)
What does a growth curve have to include?
weight, height and head circumference
What is a bone age? Where is it conducted?
Bone age is a standardized assessment of growth plate maturation of the left hand. Compare it to Gruelich and Pyle standards.
How do you assess linear growth velocity?
Assess two points at least six months apart from a growth curve.
What is the predictable pattern for malnutrition?
Weight is affected (falling away from the curve) before height. Head circumference which is a reflexion of brain growth is the last parameter to be affected.
What is most considered diagnosis if height is more affected than weight on a growth curve?
Endocrine cause. Growth hormone or thyroid hormone deficiency.
What would Cushing’s syndrome growth curve look like?
Linear growth failure in the face of increased weight. (Glucocorticoid excess)
What is the definition of genetic short stature?
Adult males as heigh less than 66 inches and in females less than 61 inches.
In history, one or both parents are short.
Negative past medical history, negative ROS and normal PE.
Bone age = chronological age
No delay in puberty
Normal growth rate.
What does CDGP stand for?
Constitutional Delay of Growth and Puberty
Describe CDGP
short stature with normal growth velocity.
Parent or sibling with CDGP with 40-60% incidence. (for mom ask for delayed menarche, dad ask for growth after high school)
Children acquire and loss teeth at delayed age, delayed bone age, experience puberty and growth spurt later.
Bone age is consistent with height age which is younger than chronological age.
Compare bone ages for genetic short stature and CDGP.
For genetic short stature, bone age equals chronologic age. For CDGP, bone age is younger than chronologic age.
Intrauterine Growth Retardation
Infants with low birth length and weight for gestational age may never catch up growth in first years of life. Final adult height is compromised.
What is the most common cause worldwide of growth failure?
Chronic malnutrition.
