S1 Endo Patho

Question 1

What are the growth Major problems ?

Answer 1

• Short stature
• Tall stature
• Development of secondary sexual characteristics

Question 2

What are the direct effects of GH ?

Answer 2

On liver :

• glucose syntheses ( gluconeogensis ) and utilization ( for this reason it is increasing during hypoglycemia )
• RNA synthesis
• protein synthesis
• IGF-1

On muscles :

• Amino acid uptake
• protein synthesis

On adipose:
Lipolysis ( so in GHD there will be increase in fat deposition )

Question 3

What are the causes of short stature ?

Answer 3

1. Physiological
   * Constitutional delay
   * Familial short stature
2. Chromosomal anomalies
   * turner
   * down
3. GH deficiency
   Children: dwarfism
   Adults : panhypopitutirism
4. Other diseases
   * primary ( congenital )hypothyroidism
   * congenital heart disease

Question 4

What are the causes of tall stature ?

Answer 4

1. Physiological
   * Hereditary (2 tall parents)
   * Idiopathic (constitutional)
   * Early development
2. Chromosomal abnormalities
   * Klinefelter’s syndrome
   * Marfan’s syndrome
3. GH excess
   * Gigantism (children)
   * Acromegaly (adults)

Question 5

What are the Investigations of short stature ?

Answer 5

1. Standardized hight charts
2. GH status
   * random ( baseline) GH > not specific or sensitive
   * dynamic ( stimulation ) GH > by insulin / drugs(clondine-arginine-Ldopa) /exercise/ stress
   * age and gender specific IGF-1 ( used to confirm the diagnosis )
3. MRI of pituitary
4. X-ray of the affected bones ( bone age )
5. Exclude different conditions :
   * systemic diseases
   * congenital heart disease
   * hypothyroidism ( by checking thyroid hormones )
   * chromosomal abnormalities ( down or turner )

Question 6

What are the Investigations of long stature ?

Answer 6

1. Standardized hight charts
2. GH status
   * random ( baseline) GH > not specific or sensitive ( if undetectable you can exclude acromegaly/ not necessarily)
   * dynamic ( stimulation ) GH > by OGTT ( GH should normally decrease )
   * age and gender specific IGF-1 ( used to confirm the diagnosis )
3. MRI of pituitary
4. Visual field defects
5. Pituitary hormone secretion decrease , prolactin increase ( in 1/4 of acromegaly cases )

Question 7

When total pituitary hormone suppression can occur in response to GH ?

Answer 7

1. In GHD
   - specifically in the adults ( panhyopopituitarism )
2. In excess GH
   - as all hormones will decrease except prolactin