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reproduction, development and aging > post natal growth > Flashcards

post natal growth Flashcards

1
Q

what does normal growth within childhood depend upon

A
  • good general health
  • normal nutrition and genetics
  • adequate nutrition
  • caring environment
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2
Q

abnormal growth disorders

A
  • genetic
  • endocrine
  • cartilage or bone
  • general chronic disease

early detection and treatment of the underlying condition is key in ensuring children reach their potential

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3
Q

phases of growth (karlberg graph)

A

infant

  • rapid growth at birth
  • declining rapidly over the first 2 years (less GH dependent)

childhood
- constant annual growth (GH dependent)

puberty
- rapid growth dependent on sex steroids and increased GH release

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4
Q

Mid-parental height

A

an estimate/guide to height potential based solely on parents height

for boys
= (dads height + (mums height + 13cm))/2

for girls
= (dads height - 13cm) + mums height)/2

MPH range is +/- 8cm

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5
Q

height velocity

A
  • HV differentiates normal variant short stature from pathological short stature
  • ideally calculated over 6-12 month interval (reduces measurement error)
  • ‘normal’ lies within 25-75% centile
  • tracks over time
  • HV curve is shaped differently in children with delayed or early puberty
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6
Q

HV sex differences

A

puberty peak growth is early in girls than boys

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7
Q

short stature

A
  • common clinical presentation
  • a symptom or a variant NOT a disease
  • may represent a variant of normal growth
  • may indicate pathology
  • normal SS still grows with normal HV
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8
Q

short stature history taking

A
  • mother and fathers heights (MPH measured)
  • family Hx delayed puberty
    • menarche >14 yrs in females
    • continued growth after high school in males
  • look at other siblings child development records
  • symptoms of underlying illness
  • etc e.g. medication taking
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9
Q

bone age

A
  • imprecise picture matching (xray)
  • 1 year intervals
  • predicted adult height from bone age
  • hand used as it has many long bones
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10
Q

normal variant short stature

A
  • familial SS
  • constitutional delay of growth and development (CDGD)
  • account for >95% of children who present with SS
  • hallmark = normal HV
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11
Q

differences between FSS and CDGD

e.g. birthweight, family Hx, late childhood HV, bone age, puberty, final height

A 
birthweight = normal
family history = both
late childhood HV = slow for CDGD
bone age = delayed for CDGD
puberty = delayed for CDGD
final height = FSS short (CDGD normal)
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12
Q

what increases growth hormone secretion

A
  • sleep
  • exercise
  • stress
  • hypoglycaemia
  • amino acids
  • malnutrition
  • sex steroids
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13
Q

what decreases growth hormone secretion

A
  • obesity

- psychosocial deprivation

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14
Q

GH axis

A
  1. GHRH from the hypothalamus acts on the pituitary to release growth hormones
  2. these GH act on adipose tissue, stomach and liver
  3. liver releases IGF-1
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15
Q

growth hormone actions

A

metabolic

  • inhibits glucose uptake and promotes glycogenolysis (anti-insulin)
  • stimulates protein synthesis
  • promotes lipolysis
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16
Q

IGF-1

A
  • major post-natal growth promoting factor
  • principally produced in the liver (endocrine) and bone (paracrine, autocrine)
  • insulin-like (promoting glucose, lipid and A.A uptake)
    - cell proliferation and differentiation
17
Q

estrogens affect on growth

A
  • effects skeleton and body composition
  • has a greater effect than testosterone on skeleton
  • responsible for epiphyseal maturation/closure in both sexes

if theres no E2 growth plates dont fuse and growth doesnt stop

18
Q

intrauterine growth retardation / small for gestational age

IUGR/SGA

A
  • very common
  • birthweight <10th PC for gestational age
  • catch-up growth above 3rd PC usually occurs by 6 mnths of age but may drag for 2 yrs
  • SS by 2yrs usually associated with short final height
  • on average dont reach MPH
19
Q

turners syndrome

A
  • consider in all girls with unexplained SS or height below MPH range
  • commonest feature is short for MPH
  • 50% will only present with SS
  • may also present with poor HV or delayed puberty
20
Q

clinical presenting of Turner syndrome

A
  • neck webbing
  • hand and foot edema as an infant
  • wide spaced nipples
  • increased carrying angle
  • cardiac abnormalities
  • renal/urinary tract abnormalities

may just present with SS or failure to enter puberty

21
Q

investigations for Turner syndrome

A

karyotype = typically 45XO

  • normal TFT
  • elevated FSH and LH: primary gonadal failure
22
Q

what determines growth

A
  • genetics
  • general health
  • hormonal milieu
  • nutrition
  • caring environment
23
Q

normal causes of short stature

A

familial SS
- short parents

congenital delay of growth and development
- delayed puberty

24
Q

abnormal causes of short stature

A

presents with poor height velocity

  • many systemic illnesses e.g. renal failure
  • hormone deficiency e.g. GH, thyroid
  • dysproportionate: the skeletal dysplasias
  • small for gestational age / IUGR
25
Q

what promotes IGF-1 production and what inhibits it?

A

normal levels of insulin and normal nutrition are essential for the normal hepatic IGF-1 production

malnutrition or poorly controlled diabetes inhibit hepatic IGF-1 production

reproduction, development and aging (27 decks)

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