Lecture 14: Growth, Puberty and Psychiatric Problems Flashcards
what assessment tools are used to assess normal growth and pubertal development?
- height/length/weight
- growth charts and plotting
- MPH and target centiles
- growth velocity
- bone age
- pubertal assessment (e.g. Tanner)
describe the Tanner method for staging of puberty
- B: 1-5 (breast development)
- G: 1-5 (genital development)
- PH: 1-5 (pubic hair)
- AH: 1-3 (axillary hair)
- T 2ml to 20ml (testicle volume)
what measurement tool is used for testicular volume?
Prader Orchidometer
list the factors influencing height
- age
- sex
- race
- nutrition
- parental heights
- puberty
- skeletal maturity (bone age)
- general health
- chronic disease
- specific growth disorders
- socio-economic status
- emotional well-being
what are the most important and earliest objective signs of puberty?
- breast budding (Tanner stage B2) in a girl
- testicular enlargement (Tanner stage G2-T 3-4ml) in a boy
- earliest objective signs of puberty and when present puberty will usually progress onwards
list the indications for referral in suspected growth disorders
- extreme short or tall statures (off centiles)
- height below target height
- abnormal height velocity (crossing centiles)
- history of chronic disease
- obvious dysmorphic syndrome
- early/late puberty
what are common causes of a short stature?
- familial
- constitutional (delayed puberty)
- being born small for gestation age (SGA)/intrauterine growth retardation (IUGR)
list the pathological causes of short stature
- undernutrition
- chronic illness (JCA, IBD, Coeliac)
- iatrogenic (steroids)
- psychological and social
- hormonal (GHD, hypothyroidism)
- syndromes (Turner, Prader-Willi, Noonan’s)
what is considered early puberty in boys?
< 9 years old
what is considered delayed puberty in boys?
> 14 years old (common, especially constitutional delay of growth and puberty (CDGP))
what is considered early puberty in girls?
< 8 years old
what is considered delayed puberty in girls?
> 13 years old (rare)
what is central precocious puberty?
- refers to premature activation of the hypothalamic-pituitary-gonadal (HPG) axis, resulting in early puberty.
what investigations are performed for suspected central precocious puberty?
Girls:
- usually idiopathic
- pituitary imaging
Boys:
- look for underlying cause i.e. brain tumour?
what is the treatment for central precocious puberty?
GnRH agonist
