Introduction to growth Flashcards
What should babies and toddlers wear when being weighed?
babies naked
toddlers in vest and pants, no shoes
What is used to measure height?
stadiometer
How do you describe changes in a child’s height or weight over time?
falls or rises should be expressed as multiples of centiles spaces from a growth chart
eg. a fall of 2 centile spaces
Target height calculation for a boy
(mother’s height + father’s height +13)/2
mid-parental height +/-5
Target height calculation for a girl
(mother’s height + father’s height -13)/2
mid-parental height +/-5
Normal childhood growth phases
3 phases
infancy = most rapid growth phase
mid-childhood = 5-7cm/year, no difference between males and females
puberty = males start puberty later and have a larger growth spurt
List some causes of short stature
congenital hypothyroidism
juvenile hypothyroidism
growth hormone deficiency
Turner’s syndrome
familial short stature
Cushing’s syndrome
Prader-Willi syndrome
When would you be more concerned short stature is down to a hormone problem?
if height is more affected than weight
eg. relatively normal weight gain
Prognosis of late-detected congenital hypothyroidism
cretinism
irreversible mental handicap
What tests should be done in suspected growth hormone deficiency?
growth hormone + GnRH test
cranial MRI (looking at pituitary
When does the pituitary gland develop?
6 weeks gestation
Why can’t you measure growth hormone randomly?
produced in peaks overnight
Growth hormone deficiency features
truncal adiposity
mid facial hypoplasia
neonatal jaundice
hypoglycaemia
Turner’s syndrome features
high palate
small hands
hypoplastic ridged nails
increased carrying angle
Turner’s syndrome karyotype
45XO/46XX
FSH and LH in Turner’s syndrome
high
due to premature ovarian failure
Turner’s syndrome treatment
growth hormone
oestrogen
Familial short stature features
current height centile = genetic centile
bone age = chronological age
no need for treatment
normal pubertal age
Describe constitutional delay in growth
short stature - generally after 1-2 y of age
normal growth velocity, lower end
bone age = height age = delayed bone age
associated with delayed but normal puberty
may need pubertal induction with testosterone at appropriate age
Cushing’s syndrome features in children
central obesity
growth failure
hypertension
psychological effects
Causes of Cushing’s syndrome in children
ACTH dependent:
- pituitary
- ectopic ACTH
Adrenal tumour
Prader-Willi syndrome features
infantile hypotonia
insatiable appetite
short stature
subtle dysmorphic features
moderate learning disability
behaviour problems
Genetic cause of Prader-Willi syndrome
paternal 15q11 deletion
What would suggest androgen exposure in a baby/child?
body odour
pubic/axillary hair
no breast development
[normal puberty = breast buds develop first]
What hormone is high in congenital adrenal hyperplasia?
17 alpha hydroxyprogesterone
What causes congenital adrenal hyperplasia?
21 hydroxylase deficiency
11 beta hydroxylase deficiency
17 hydroxylase deficiency
Medical management of congenital adrenal hyperplasia?
hydrocortisone
fludrocortisone
sodium chloride (lots of salt loss occurs in this condition so needs replacing)
monitor testosterone, 17OHP, growth, bone age, puberty
