Worrisome Growth

Question 1

Mid Parental Height

Answer 1

Boys: (mom + dad’s height + 5)/2
Girls: (dad - 5 + mom)/2

Question 2

Dwarfism

Answer 2

height below -3 SD for age

Question 3

Abnormal growth velocity

Answer 3

slow linear or dropping across 2 major centile lines

Question 4

Constituitonal short stature/late bloomer

Answer 4

Growth deceleration first 2 yrs then normal growth
Catch up w/ late puberty
Younger bone age
Can treat boys w/testosterone if bone age > 11-12 yrs

Question 5

Nutritional Causes for Short Stature

Answer 5

Zn, Fe Deficiency
Anorexia
IBD, Celiac, CF

Question 6

Skeletal Dysplasia

Answer 6

SHOX - on short arm of X if def then short

Brachydactyly syndrome

Question 7

Turner’s syndrome

Answer 7

Haploinsufficiency of SHOX genes - absence of X gene
Short stature (can give GH)
Webbed neck, low ears, low hair, cardiac/kidney abnorm

Question 8

Noonan syndrome

Answer 8

abnormal GH post-receptor

Similar symptoms as Turner’s but both sexes

Question 9

Hypothyroid Growth Problems

Answer 9

Primary hyopothyroidism - high TSH, low T4
Central - low T4, low/normal TSH
Puffy cheeks

Question 10

GH Deficiency Growth Problems

Answer 10

decreased muscle, increased subcutaneous trunk fat, face immature for age, prominent
forehead/depressed midface, small phallus in males, other midline facial defects, may have hx of prolonged jaundice and/or
hypoglycemia in newborn
Young bone age
Low IGF-1 (low in underweight too thought)
Low stimulation GH on stimulation

Question 11

Small for Gestational Age

Answer 11

Less than 2 SD for birth weight or length
Can cause resistance to GH, IGF-1, & insulin
Most healthy ones catch up by age 2. GH if don’t