Newman Clin Med Flashcards
Discuss the information garnered by a single point on the growth chart.
single point= how they plot on the curve THAT day
what is necessary to evaluate rate of growth/growth pattern?
Multiple points
NL BMI
“NL” = 18.5 - 24.9
- State the normal growth velocity for school age children.
NL rate of linear growth5YO => puberty is 5cm/year (2 inches/year).
Growth parameter most commonly 1st affected in children with endocrine growth disorders.
Length or height
- Define what is meant by “delayed bone age.”
2 standard deviations or more below the chronologic age of the patient = delayed
when should we begin to become concerned about growth patterns on a charge
when the points plotted on the growth chart for one (or all) growth parameters begin to deviate up or down from what had been the normal growth rate for that child
Growth parameters on a growth chart include
- height (or length if <24 months)
- weight
- BMI (if >36 months-of-age)
- head circumference (if <24 months-of-of age)
- if height parameter changes FIRST or more dramatically = think ________
- if weight parameter changes FIRST or more dramatically = think _______
- if head circumfrance changes 1st or more dramatically = think __________
- if height parameter changes FIRST or more dramatically = think endocrine
- if weight parameter changes FIRST or more dramatically = think calories/nutrition
- if head circumfrance changes 1st or more dramatically = think brain/skull/hydrocephalus
conclusions?
child is big, but well-proportioned. no problems :)
conclusions?
bbs weight has fallen off 1st and most dramatically: think caloric deprivation
- not getting fed enough
- not retaining enough calories (GERD, malabsoprtion)
- Being fed NL, but metabolic demands are higher than NL (hyperthyroidism, congenital <3 dz)
conclusions
Head circumfrances shows RAPID growth = hydrocephalus
concluision?
length is falling off 1st and more dramatically: think endocrine (growth hormone deficiency)
what is short stature?
- height > 2 SD below the mean height (50th percentile) for age and sex (below 3%))
- height is 2 SD below the mid-parental height
what are the 3 most common benign causes of short stature?
- familial (parents are small)
- constitutional growth delay
- Idiopathic (no endocrine, metabolic, other dx, no FHx)
how we can ID familial causes of short stature on a chart?
Growls with NL velocity in all parameters; just plot lower on the growth cruve and their end height is consistent with mid-parental height.
what is bone age?
- Bone age = gives us a rough estimate of a child’s skeletal maturation by assessing the ossification of the epiphyseal centers
- Bone age should be consistent with chronological age; if 2 SD below chronological age = delayed.
What is constitional growth delay of short stature?
- Delayed puberty, however a puberty/growth spurt occur and the end height is NL.
- Usually FHx of “late bloomers”
how we can ID constitional causes of short stature on a chart?
grow at a low NL rate and plot low on growth curve.
Hallmark of constitional causes of short stature
delayed bone growth
how we can ID idiopathic causes of short stature on a chart?
Height is MORE than 2 SD below the mean for height for age.
Which causes of short stature are the [bone age] consistent with [chronological age]?
- Familial
- Idiopathic
Discuss the importance of Insulin-like Growth Factor (IGF-1) and IGF Binding Protein 3 (IGFBP-3) in the work-up of short stature.
What are they?
- IGF-1 = hormone that is the major mediator of GH stimulated somatic growth
- IGFBP-3 = main IGF-1 transport protein in the blood
What proves that IGF-1 contributes to statural growth?
GH = ↑ IGF–1 synthesis by osteoblasts and chondrocytes.
Discuss the importance of Insulin-like Growth Factor (IGF-1) and IGF Binding Protein 3 (IGFBP-3) in the work-up of short stature.
- ↓ in IGF-1 and IGFBP-3 levels on work- up = ↓ GH
When is the best time to check IGF-1 and IGFBP-3 levels?
Anytime :)
Levels are stable throughout the day because GH secretion is pulsatile
If IGF-1 and IGFBP-3 levels are ↓, what should be done?
[Growth hormone stimulation testing]
What are the 3 most reliable [GH stimulation tests]?
- Administration of glucagon
- Administration of arginine
- Insulin induced hypoglycemia
Define precocious puberty
Onset of secondary sexual characteristics
- Before 8 YO in girls
- Before 9 YO in boys
Define precocious puberty and discuss the clinical settings in which the diagnosis should be
considered (in boys and girls).
Girls: progressive breast development and crossing major percentile lines upward on the linear growth chart
Boys: evidence of both testicular and penile enlargement and crossing major percentile lines upward on the linear growth chart
Describe the basic work-up (growth measurements, lab, x-rays, etc.) for suspected precocious
puberty.
1. Hx and PE
2. Labs
3. Imaging
H&P for precocious puberty
- FHx of precocious puberty?
- 2. Exogenous steroids?
- Throrough neurologic ROS and exam
Labs for precocious puberty
- LH/FSH
- Estradiol and/or testosterone
- 17-hydroxyprogesterone
Imaging for precocious puberty
- 1. Bone age (will be advanced in precocious puberty)
- 2. MRI of head (CNS tumor?
- 3. US of gonads
