Pediatric Endocrine (mostly growth) Flashcards
What is the growth rate from age 6 until puberty
at least 5 cm/year (2 inches)
What do you think when weight falls off first
Think nutrition
- Not enough in (emesis, no food)
- Not enough absorbed (malabsorptive conditions)
- Higher than average caloric requirements
What do you think when length falls off first
Think endocrine
- GH deficiency
- Hypothyroidism
- Cushing’s syndrome (iatrogenic?)
What do you think when head circumference falls off first
– Primary failure of the brain to grow
– Severe craniosynostosis
What is the purpose of measuring bone age
Provides an rough estimate of a child’s skeletal maturation by
assessing the ossification of the epiphyseal centers.
When is bone age considered delayed
Bone age that is two standard deviations below the chronologic age is considered delayed.
What is essential in developing the differential diagnosis and guiding the workup of abnormal growth
A comprehensive history and physical
What often occurs as more table food is introduced to children/infants
Some kids make up to a 25% downward correction on the growth curve
If less than 36 months of age and using the 0-36 month curve,
measure length while child is …
supine (length)
If older than 24 months, may use the 2-20 yo chart but the height
must be measured…
standing up (stature)
Define short stature
– Height 2 Std Dev below the mean height for age and sex (<3%ile)
– Height more than 2 Std Dev below the mid –parental height
What is an important part of the initial workup for short stature
IGF and IGFBP-3 levels
What does a growth hormone deficiency look like in the neonate
- Midline defects
- Microphallus
- Hypoglycemia
- GH not relevant for growth during the first year of life
What does a growth hormone deficiency look like in children
– Decreasing growth velocity
– Low IGF-1 and low IGFBP-3 levels
– Low GH levels during stimulation test (using insulin, arginine, or clonidine)
What should you always check with delayed puberty/short stature in females?
a karyotype
