Short Stature/Failure To Thrive

Question 0

How do you calculate midparental height for boys? For girls?

Answer 0

Boys: (mom’s height + dad’s height + 13cm/ 2) +/- 10cm
Girls: (mom’s height + dad’s height - 13cm/2) +/- 10cm

Question 1

Important things to ask when assessing growth (6)

Answer 1

Has the child always been small?
Are other children who were smaller now surpassing them?
Clothes and shoe size? Are they changing?
Parental height?
Child puberty stage? Parental puberty experience?

Look at growth velocity => are they following a curve?

Question 2

What is the minimum normal growth velocity?

Answer 2

4 cm/year minimum

Question 3

Constitutional delay: is treatment with Growth hormone an option? What about sex steroids?

Answer 3

GH: NO!!!

Sex steroids: maybe…..treatment in boys over 14 and girls over 13, no longer than 6 months of treatment.

Question 4

Definition of constitutional growth delay

Answer 4

Constitutional growth delay (CGD) is a term describing a temporary delay in the skeletal growth and thus height of a child with no other physical abnormalities causing the delay. Short stature may be the result of a growth pattern inherited from a parent (familial) or occur for no apparent reason (idiopathic). Typically at some point during childhood, growth slows down, eventually resuming at a normal rate. CGD is the most common cause of short stature and delayed puberty.

Question 5

Causes of abnormal growth velocity (4)

Answer 5

Chronic illness (screen with CBC, ESR, BUN, creatinine, blood gas, LFTs, total protein, albumin, TTG with IgA, U/A)
Syndrome (ex. Turner Syndrome (45X) => screen with LH, FSH and karyotype)
Endocrinopathies such as hypothyroidism (TSH/free T4), growth hormone deficiency (NO value in random GH, GH stimulation tests, evaluate other pituitary hormones, might do IGF-1 if available), cortisol excess

Question 6

Describe the characteristics of Turner Syndrome

Answer 6

There are characteristic physical abnormalities which affect many but not all people with Turner syndrome, such as short stature, swelling, broad chest, low hairline, low-set ears, and webbed necks.
Girls with Turner syndrome typically experience gonadal dysfunction (non-working ovaries), which results in amenorrhea (absence of menstrual cycle) and sterility.
Concurrent health concerns may also be present, including congenital heart disease, hypothyroidism (reduced hormone secretion by the thyroid), diabetes, vision problems, hearing concerns, and many autoimmune diseases.
Finally, a specific pattern of cognitive deficits is often observed, with particular difficulties in visuospatial, mathematical, and memory areas.

Question 7

Classic growth pattern in Turner Syndrome

Answer 7

Fall off the curve around age 5-6 years

Question 8

Treatment for Turner Syndrome

Answer 8

Growth hormone is offered to all girls with Turner syndrome