Short Stature Flashcards by Ahmed Farag

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Def of Short Stature

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Z-Score

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Def of Short Stature

Proportionate

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Def of Short Stature

Disproportionate

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Tools used to define growth in children

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Factors affecting height & growth

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Mid parental height

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Causes of abnormal growth in children

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Causes of abnormal growth in children

Normal Variants

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Causes of abnormal growth in children

Syndromes

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Causes of abnormal growth in children

Chronic Diseases

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Causes of abnormal growth in children

Endocrine

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Q

CA, BA, HA in Familial (Genetic) Short Stature

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(CA = ВА) > НА

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Growth Velocity in Familial (Genetic) Short Stature

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Normal

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Prognosis of Familial (Genetic) Short Stature

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The child grows within the expected target height centile (MPH +- 5).

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CA, BA, HA in Constitutional Short Stature

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СА > (BA = НА)

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Constitutional Short Stature is associated with …..

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associated with delayed puberty

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Hx in Constitutional Short Stature

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positive family history

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TTT of Constitutional Short Stature

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Testesterone for 6 months at bone age 12.5 years for growth & 2ry sex characters

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Q

Compare between Familial Short Stature in terms of

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Compare between Familial Short Stature in terms of

Sex
Family Hx
Height Velocity
Puberty
Bone Age
Final Height

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Def of

CA
BA
HA

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Classification of Short Stature

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Classification of **Short Stature** - Normal Variants

Classification of **Short Stature** - Pathological Variants

Classification of **Short Stature** - Proportionate

Classification of **Short Stature** - Disproportionate

Assessment of Short Stature

- Hx - Ex - INVx

Assessment of Short Stature - Hx

Clues to Etiology of Short Stature From History - **History of Delayed of Puberty in Parents**

Constitutional delay of growth

Clues to Etiology of Short Stature From History - **LBW**

SGA

Clues to Etiology of Short Stature From History - **Neonatal Hypoglycemia, Jaundice, Micropenis**

GH deficiency

Clues to Etiology of Short Stature From History - Dietary Intake

Under nutrition

Clues to Etiology of Short Stature From History - Headache, Vomiting, Visual Problems

Pituitary/ hypothalamic SOL

Clues to Etiology of Short Stature From History - Lethargy, Constipation, Weight Gain

Hypothyroidism

Clues to Etiology of Short Stature From History - **Polyuria**

CRF, RTA

Clues to Etiology of Short Stature From History - **Social History**

Psychosocial dwarfism

Clues to Etiology of Short Stature From History - **Diarrhea, Greasy Stools**

Malabsorption

Assessment of Short Stature - Complete Physical Exam

Pointers to Etiology of Short Stature - **Midline defects, micropenis, Frontal bossing, depressed nasal bridge, crowded teeth**

GH deficiency

Pointers to Etiology of Short Stature - Rickets

Renal failure, RTA, malabsorption

Pointers to Etiology of Short Stature - Pallor

Renal failure, malabsorption, nutritional anemia

Pointers to Etiology of Short Stature - Malnutrition

PEM, malabsorption, celiac disease, cystic fibrosis

Pointers to Etiology of Short Stature - Obesity

Hypothyroidism, Cushing syndrome, Prader Willi syndrome

Pointers to Etiology of Short Stature - **Metacarpal Shortening**

Turner syn., pseudohypoparathyroidism

Pointers to Etiology of Short Stature - Cardiac Murmur - Mental Retardation

- Congenital heart disease, Turner syndrome - Hypothyroidism, Down/ Turner syndrome, pseudohypoparathyroidism

Pointers to Etiology of Short Stature from Ex - **Disproportion**

Skeletal dysplasia, rickets, hypothyroidism

Pointers to Etiology of Short Stature from Ex - **Dysmorphism**

Congenital syndromes

Pointers to Etiology of Short Stature from Ex - **HTN**

CRF

Pointers to Etiology of Short Stature from Ex - **Goiter, Coarse Skin**

Hypothyroidism

Pointers to Etiology of Short Stature from Ex - **Central Obesity, Striae**

Cushing syndrome

Investigations for **Short Stature**

Investigations for **Short Stature** - Bone Age

- Patients diagnosed with growth hormone deficiency should undergo an MRI of the head to exclude a brain tumor (e.g., craniopharyngioma)

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- 15% of patients with growth hormone deficiency have an abnormality of the pituitary gland (e.g., ectopic bright spot, empty or small Sella).

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TTT of **Short Stature**

TTT of **Short Stature** - From Notes

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TTT of **Short Stature** - Small for Gestational Age

growth hormone therapy

TTT of **Short Stature** - Psychosocial Dwarfism

psychological support

When to Refer Cases of Short Stature?

When to Refer Cases of Short Stature? - Anthropometry

When to Refer Cases of Short Stature? - Female Puberty

* If no breast disk /pubic hair /axillary hair at age of 13ys for females. * If no menarche at age of 16 years.

When to Refer Cases of Short Stature? - Male Puberty

* If size of testes is less than 3ml at age of 14 years.

When to Refer Cases of Short Stature? - General Examination

Algorithm for **Short Stature**

Etiology of **GH Deficiency (Pituitary Dwarfism)**

Etiology of **GH Deficiency (Pituitary Dwarfism)** - Most Common Cause

Idiopathic

CP of **GH Deficiency (Pituitary Dwarfism)**

CP of **GH Deficiency (Pituitary Dwarfism)** - At Birth

**GH Deficiency (Pituitary Dwarfism)** - During Childhood

CP of **GH Deficiency (Pituitary Dwarfism)** - Cases with Destructive pituitary lesion

INVx for **GH Deficiency (Pituitary Dwarfism)**

INVx for **GH Deficiency (Pituitary Dwarfism)** - GH Provocation Test

TTT of **GH Deficiency (Pituitary Dwarfism)**

TTT of **GH Deficiency (Pituitary Dwarfism)** - GH Replacement

TTT of **GH Deficiency (Pituitary Dwarfism)** - Dose of GH

- Total dose: 0.3 mg/kg/week or 15 IU/m2/week. - 6-7 shots/week

TTT of **GH Deficiency (Pituitary Dwarfism)** - Effects of GH Therapy

- It gives drama catch up growth (10-12 cm/y) in the 1st year, then 1.5 times of normal in subsequent years.

TTT of **GH Deficiency (Pituitary Dwarfism)** - When to Stop GH?

Growth hormone therapy is discontinued at bone age: - 16 years in males - 14 years in females

TTT of **GH Deficiency (Pituitary Dwarfism)** - Replacement therapy for other hormones

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