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Endo > SM_194b: Growth and Development > Flashcards

SM_194b: Growth and Development Flashcards

1
Q

Phases of growth are ____, ____, and ____

A

Phases of growth are fetal, infancy and childhood, and adolescent

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2
Q

Normal intrauterine growth is largely ___ of the fetal pituitary gland hormones

A

Normal intrauterine growth is largely independent of the fetal pituitary gland hormones

  • At midgestation, fetus grows 2.5 cm/week
  • Prenatal growth is controlled by different mechanisms than postnatal growth
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3
Q

____ is the main source of nutrition and oxygen to the fetus

A

Placenta is the main source of nutrition and oxygen to the fetus

  • Abnormal implantation, vascular insufficiency, infarction can compromise supply of oxygen and nutrients to fetus
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4
Q

Maternal influences on fetal growth are ___, ___, and ___

A

Maternal influences on fetal growth are malnutrition, hypertension, and drugs / alcohol

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5
Q

Endocrine regulators of fetal growth are ____, ____, ____, and ____

A

Endocrine regulators of fetal growth are insulin, insulin-like growth factors (IGF-I, IGF-II), thyroid hormone, and growth hormone

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6
Q

___ is the major endocrine regulator of fetal growth

A

Insulin is the major endocrine regulator of fetal growth

Infants of diabetic mothers are born large

Infants with leprechaunism are born small for gestational age

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7
Q

Local production of ___ is critical for normal intrauterine growht

A

Local production of insulin-like growth factors (IGF-I and IGF-II) is critical for normal intrauterine growht

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8
Q

Newborns with congenital hypothyroidism or GH deficiency are usually ___ size at birth

A

Newborns with congenital hypothyroidism or GH deficiency are usually normal size at birth

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9
Q

Postnatal growth is influenced by ____, ____, ____, ____, and ____

A

Postnatal growth is influenced by nutrition, metabolic, hormones, genetics, and psychosocial factor

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10
Q

____ and ____ are major endocrine regulators of growth in infancy and childhood

A

Thyroid hormone and GH are major endocrine regulators of growth in infancy and childhood

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11
Q

Thyroid hormone has ____ and ____ in infancy and childhood

A

Thyroid hormone has direct effect on epiphyseal cartilage and permissive effect on GH secretion in infancy and childhood

  • Epiphyseal cartilage: chondrocyte proliferation, epiphyseal fusion
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12
Q

GH is secreted from ____, in ____ fashion, with greatest amplitude ____, and regulated by ____ and ____

A

GH is secreted from anterior pituitary somatotrophs, in pulsatile fashion, with greatest amplitude overnight, and regulated by GHRH (+) and somatostatin (-)

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13
Q

Describe the GH / IGF-1 axis

A

GH / IGF-1 axis

  1. Hypothalamus secretes GHRH
  2. Pituitary secretes GH
  3. Acts on GH receptor on target tissue and IGF-1 receptor on bone
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14
Q

GH acts on ___, ___, ___, and ___

A

GH acts on bone, linear growth, adipose tissue and muscle

  • Increases osteoclast differentiation and activity, increases osteoblast activity, increases bone mass by endochondral bone formation
  • Promotes epiphyseal growth, stimulates differentiation of prechondrocytes and focal expression of IGF-1
  • Increases lipolysis, decreases lipogenesis
  • Increases amino acid transport, increases nitrogen retention, increases lean tissue, and increases energy expenditure
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15
Q

GH primarily functions to ____ in childhood via ____ and ____

A

GH primarily functions to promote linear growth in childhood via directn effect on bone and indirectly by stimulating IGF-1 production

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16
Q

IGF-1 is ___, is produced based on ___, and is responsible for ___

A

IGF-1 is the most important IGF for postnatal growth, is produced based on GH secretion, and is responsible for stimulating muscle and cartilage growth

  • Rises significantly during puberty
  • Critical mediators of growth
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17
Q

____ is the main carrier of IGF-1 in the body

A

IGFBP-3 is the main carrier of IGF-1 in the body

18
Q

Puberty is regulated by the ____

A

Puberty is regulated by the hypothalamic-pituitary-gonadal axis

  • Sex steroids, estrogen, and testosterone produce the physical changes of puberty and promote the growth spurt
19
Q

Measure length / height at age 0-2 ___

A

Measure length / height at age 0-2 supine

20
Q

Measure length / height at age 2+ ___

A

Measure length / height at age 2+ standing up

  • At age 2, length typically 1 cm longer than standing height
  • Height percentile may decreases at age 2 due to a change in measurement technique
21
Q

Describe growth measurements

A

Growth measurements

  • Can also measure arm span, upper segment and lower segment, upper to lower segment ratios
  • Other helpful tools include: mid-parental height (target height) and bone age
22
Q

Mid-parental height for girls = _____

A

Mid-parental height for girls =

[(paternal height - 5 in) + maternal height] / 2

23
Q

Mid-parental height for boys = ____

A

Mid-parental height for boys =

[Paternal height + (maternal height + 5 in)] / 2

24
Q

Describe growth rate

A

Growth rate

  • Poor correlation between birth height and adult height, improves by age 2
  • 2/3 of all children will cross growth percentiles in the first 2 years of life
  • Peak growth rates occur in 1st year of life and during puberty
25
Q

Describe red flags for growth

A

Red flags for growth

  • Height < 3rd percentile
  • Height significantly below genetic potentional
  • Abnormally slow growth rate
  • Downwardly crossing percentile channels after 18 months - 2 years of age
26
Q

Short stature is ____

A

Short stature is height SDS < -2 for age and sex

  • Approximately 3% of all children
  • Does not automatically imply pathology
27
Q

Short stature is classified as ____, ____, and ____

A

Short stature is classified as primary growth abnormalities, secondary growth disorders, and idiopathic short stature

28
Q

Primary growth abnormalities (intrinsic growth plate abnormalities) can be caused by ____ or ____

A

Primary growth abnormalities (intrinsic growth plate abnormalities) can be caused by osteochondrodysplasias (skeletal dysplasias) or chromosomal abnormalities

  • Chromosomal abnormalities: Down’s syndrome, Turner syndrome, Russel-Silver syndrome
29
Q

In primary growth abnormalities, linear growth rate can be ____ or ____

A

In primary growth abnormalities, linear growth rate can be normal but below the typical growth curve or be normal then slow

  • Skeletal age = chronologic age
30
Q

Describe secondary growth disorders

A

Secondary growth disorders

  • Disorders of the GH-IGF axis
  • Other endocrine disorders: Cushing’s, hypothyroidism
  • Malnutrition
  • IUGR
  • Chronic diseases
  • Psychosocial disorders
  • Inflammatory disorders
31
Q

In secondary growth disorders, linear growth is ____ and ____

A

In secondary growth disorders, linear growth is slow and skeletal age is delayed

  • Bone age < chronologic age
32
Q

Endocrine causes of short stature are ____, ____, and ____

A

Endocrine causes of short stature are hypothyroidism, glucocorticoid excess, and IGF deficiency

  • IGF deficiency: hypothalamic dysfunction, pituitary GH deficiency, and GH resistance
33
Q

In hypothryoidism, there will be ____ and ____

A

In hypothryoidism, there will be profound growth deceleration / failure and delayed puberty (except Van Wyk Grumbach Syndrome)

34
Q

Glucocorticoid excess ___

A

Glucocorticoid excess suppresses GH and IGF-1 action at the growth plate

  • Causes: Cushing’s Disease (pituitary ACTH hypersecretion), cortisol secreting tumor, CRH secreting tumor, exogenous
35
Q

Describe presentation of glucocorticoid excess

A

Glucocorticoid excess presentation

  • Central obesity
  • Buffalo hump
  • Purple / red abdominal striae
  • Round face
  • Easy bruising
  • Linear growth failure
  • Plethora / reddish face
  • Osteopenia
  • Depression
36
Q

GH deficiency can result from ____ or ____

A

GH deficiency can result from hypothalamic dysfunction (impaired GHRH release) or pituitary GH deficiency

37
Q

Describe presentation of GH deficiency

A

GH deficiency presentation

  • Round, cherubic face
  • Truncal obesity
  • Small hands / feet
  • Neonatal hypoglycemia, prolonged jaundice, or micropenis
  • Hx of cranial irradiation or chemo
  • Midline defects
  • High-pitched voice
38
Q

IGF deficiency is ___ or ___

A

IGF deficiency is GH resistance (Laron syndrome) or primary defects of IGF-1 synthesis

39
Q

Laron syndrome is ____ caused by ____ or ____

A

Laron syndrome is GH resistance caused by abnormalities of the GH receptor and postreceptor abnormalities of GH signal transduction

40
Q

Describe non-pathologic causes of short stature

A

Non-pathologic causes of short stature

  • Genetic or familial short stature: bone age = chronological age
  • Constitutional delay of growth and puberty: bone age < chronological age

Endo (25 decks)

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