ICR Growth Disorders

Question 0

When is the fastest growth rate for an individual?

Answer 0

During the intrauterine period. Growth velocity averages 68 cm/year during this time.

Question 1

Normal growth is a result of the interaction between what?

Answer 1

Genetic, nutritional, environmental/social, metabolic and endocrine factors.

Question 2

When is crossing percentiles considered to be abnormal?

Answer 2

After the first two years of life.

Question 3

A child experiences growth failure when the growth rate is less than what?

Answer 3

5 cm/year

Question 4

When does the slowest growth occur?

Answer 4

Just prior to puberty

Question 5

How does the start of puberty usually manifest in a female? Male?

Answer 5

Breast development in females. Increase in testicular volume (TV) for males. TV measured by an orchidometer

Question 6

What does PHV stand for?

Answer 6

Peak Height Velocity

Question 7

What is the hormone responsible for fusion of growth plates in both men and women?

Answer 7

Estrogen. Estrogen potentiates GH secretion (age dependent) and IGF-1 axis. This is why there is a growth spurt in puberty

Question 8

What are the most important factors for normal growth prenatally?

Answer 8

Insulin, nutrition (and placental function), and general genetic endowment of the child.

Question 9

What does LGA stand for?

Answer 9

Large for gestational age

Question 10

What two hormones, which do not have a significant effect on prenatal growth, are important for growth later in life?

Answer 10

Thyroxine and growth hormone

Question 11

What three categories of medications can strongly affect growth development?

Answer 11

steroids (topical, nasal, inhaled or oral), amphetamines (ADHD), oncology medication and treatment (hypothalamus and pituitary are radiosensitive)

Question 12

What does a growth curve have to include?

Answer 12

weight, height and head circumference

Question 13

What is a bone age? Where is it conducted?

Answer 13

Bone age is a standardized assessment of growth plate maturation of the left hand. Compare it to Gruelich and Pyle standards.

Question 14

How do you assess linear growth velocity?

Answer 14

Assess two points at least six months apart from a growth curve.

Question 15

What is the predictable pattern for malnutrition?

Answer 15

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.

Question 16

What is most considered diagnosis if height is more affected than weight on a growth curve?

Answer 16

Endocrine cause. Growth hormone or thyroid hormone deficiency.

Question 17

What would Cushing’s syndrome growth curve look like?

Answer 17

Linear growth failure in the face of increased weight. (Glucocorticoid excess)

Question 18

What is the definition of genetic short stature?

Answer 18

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.

Question 19

What does CDGP stand for?

Answer 19

Constitutional Delay of Growth and Puberty

Question 20

Describe CDGP

Answer 20

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.

Question 21

Compare bone ages for genetic short stature and CDGP.

Answer 21

For genetic short stature, bone age equals chronologic age. For CDGP, bone age is younger than chronologic age.

Question 22

Intrauterine Growth Retardation

Answer 22

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.

Question 23

What is the most common cause worldwide of growth failure?

Answer 23

Chronic malnutrition.

Question 24

How can hypothyroidism present?

Answer 24

Deceleration of linear growth. Puffy face. Sallow/sullen expression.

Question 25

Severe or complete growth hormone deficiency will present how in the newborn?

Answer 25

hypoglycemia and micropenis in the male.

Question 26

What surrogate marker can you measure for GH deficiency?

Answer 26

IGF-1. Need to evaluate in context of bone age.

Question 27

What is growth hormone stimulation testing?

Answer 27

Evaluate for GH deficiency as cause of growth failure.
Administer 2 separate GH secretogogues (insulin, glucagons, L-dopa, arginine, clonidine). Measure GH level at 0,30,60,90,120.
Values less than 8-10 ng/mL are consistent with GH deficiency.