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75 Cards in this Set
- Front
- Back
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when is the fastest growth velocity
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intrauterine growth, slows after 4 months
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how many inches can an infant grow in the first year
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7-10 inches in first year
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when do girls peak growth vs boys
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girls before puberty tanner 2-3 - 2.5 to 5 inches per year
boys grow at mid puberty - 2-5inches per year |
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what interactions are involved in growth - factors
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genes
hormones nutrition enviorment |
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what is involved in genetics of growth
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numerous single genes on many chromosomes
allelic combinations of genes gene interactions enviroment gene interactions |
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adult height depends on sequential patterns of gene activity. when is growth affected
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all points in childhood prenatal to post adolescent
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how much do heredity account for growth
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>90%
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normal growth involves genes that control what in the body
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pituitary
hypothalmac control of pituitary function growth related hormones - GH, IGF-I, thyroid and sex pubertal development - timing and speed skeletal growth process at the epiphysis - growth plate - check xray |
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where are growth hormones secreted
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pituitary
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how is insulin like growth factor I involved in growth
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peptide produced in liver and other tissues in response to GH, mediates part of GH action in linear growth
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what does excess cortisol do to growth
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impairs linear growth - will have abdominal fat
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how do sex hormones influence growth
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speed linear growth during puberty and lead to growth plate fusion at the end of growth
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what nutritient is especially important for growth
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protien
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what is the most common cause of growth failure
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suboptimal nutrition - either by poverty, self restriction - picky eaters, anorexia,
chronic sinusitis - decreased appetite, sudafed or on stimulant - ADHD |
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how is environment involved in growth
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psychosocial
hygeine culture climate and season |
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how fast is growth in prenatal linear growth
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very rapid
2.5cm per week at 20weeks gestation impact - small uterus, nutrition, drugs, or smoking, low correlation between birth length and mid parental height |
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if infant premature when do you expect to catch up to regular height
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2 years
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what is initially dependent on growth before 6-8 months then what is after
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before is nutrition dependent then hormonal - return to genetic track by 2-3 years
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what two hormones are responsible for about 30% of adult stature
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GH and IGF-I together account for 30% of stature
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this is a subnormal rate of linear growth for age and sex that is persistent - lead to short stature
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growth failure
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what is the SD below normal to be considered short stature
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2 SD
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if short stature is proportionate what are some causes
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prenatal:
placental disease infection tetrogen genetic/chromosomal Postnatal: nutrition chronic disease heart disease, GI, Renal, hem Medications Dwarfism endocrine Food allergies, short gut affects growth |
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what are causes of short stature that is disproportionate
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ricketts
skeletal dysplasia |
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what growth information do you need to know when evaluating growth
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birth weight and height
growth during first year of life - catch up or catch down full term or premie |
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what medical history is important for evaluating growth
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GI, renal, cardiac and respiratory
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what family history is important for evaluating growth
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height and growth patterns of parents and sibling
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what are some questions to ask parents about the childs growth
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shortest in class
being teased about height still wear last years clothes grow less than 2 inches in a year unable to keep up with classmates show signs of puberty wear out shoes - in toes because of growth, elsewhere not growing 10 years - BO, both sexes, breast buds |
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what clues in the history of the family will cue you in to growth failure or short stature
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sibling or parents with short stature
history of abnormal growth pattern in the family parental age at conception parents height |
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what clues in the history of the child will cue you in to growth failure or short stature
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pregnancy, delivery, neonatal period
birth wt and ht feeding history - picky measurements in infancy and young childhood poor sleep history - snoring, tonsils enlarged history of emotional distress past illness or surgeries |
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how do you calculate height of child by using parents height calculation
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add mother and fathers height then divide by 2 and adjust by sex
male add 2.5inches female subtract 2.5 inches |
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what percentile is considered short stature
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below 3%
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what is constitutional delay
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bone age
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how do you calculate bone age
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by X-ray, then plot on chart. If 9 years old and bone age 6 years 10 months, will be a late bloomer, longer to develop and later to puberty
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how long do you grow after puberty
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2-3 years so if start menses young will grow only a few years after start
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if someone is short stature - that is genetic what will their bone age be
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equal to the age of bone
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what areas do you look at for growth disorder evaluation
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history of growth
family history of height and growth patterns accurate height - limb length, is it proportionate or short arms - dysmorphic careful physical exam lab to exlude other diseases |
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how do you do plotting errors
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inaccurate value recorded
used wrong gender growth chart standing height plotting in recumbent chart birthday plotting - 6.5 years but chart 7 years chart if the person who is |
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what would you suspect if a child was steadily growing then steadily trends down
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hypothyroid
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what should you do if weight stays the same at 50% but height trends down and falls off curve
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refer to endocrinology
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if a child has growth failure, what on PE should you assess and take measurements of
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proportion of trunk vs limbs (long bone)
arm span pubis to floor - leg upper and lower body ratio weight HC - till 3 - stop growing RETTS assess nutritional status - skin and mucous membranes muscle bulk sub q fat |
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what features do you look for in clues for PE
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genetic and chromosomal disorders - dysmorphic - refer to endocrine
bone dysplasia chronic systemic disease - not feeding well Refer to endo, chromosomal analysis first - dx dysmorphic features Pubertal status - tanner staging |
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what initial labs are important for growth failure diagnosis
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chemistry
blood count ESR TSH*** antibodies for GI disease IGF-I and IGFBP-3 karyotype for girls and boys |
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how do you assess skeletal maturation
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left wrist/hand X-ray to assess bone age - open vs closed epiphysis will indicate if need referral to endo
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what are major causes of endo disorders for abnormal growth
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hypothyroidism
cushings GH deficiency - congenital or acquired multiple pituitary hormone deficiency |
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what chromosomal disorders are major causes of abnormal growth
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turner
leri-weill dyschondrosteiosis prader-willi SGA |
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if there is an endo disorder causing growth abnormalities, what will you see on growth chart
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weight is the same but height tends to drop off
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this is childhood onset of severe growth failure, disproportionate weight for height, symptoms of cold intolerance, constipation, dry skin
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juvenile hypothyroidism
screens at birth |
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this is a childhood growth failure marked central weight gain, moon face and buffalo hump, skin changes of bruising and straie and HTN
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hypercortisolism - cushings
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what causes significant short stature, stuck at height hit plate, was normal
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GH deficiency, may spontaneously resolve in adolescence. Refer to endo
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what are causes of congenital GH deficiency
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idiopathic - most common
genetic defects in GH or pituitary hypopituitarism malformations - cleft lip or palate, septo-optic displasia, or single central incisor syndrome = intracranial malformations |
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what are causes of acquired GH deficiency
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trauma - breech or cerebral hypoperfusion
tumor radiation - leukemia infection - menengitis or encephalitis inflamatory or infiltrative |
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what are clinical signs of infants with congenital GH deficiency
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floppy
low sugar micropenis prolonged jaundice |
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what are signs of GH deficiency in childhood
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growth decelerate after 2 years
delayed dentition retained baby fat central obesity acromicria - small face and short limbs delayed gross motor - cannot hop on foot, clumbsy |
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what are signs of GH deficiency in teenagers
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delayed puberty, young appearance for age
central obesity |
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on exam:
prominent forehead saddle nose - wide growth failure in infancy central obesity absent puberty - not developing |
multiple pituitary hormone deficiency (MPHD)
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this is in females, prenatal onset of short stature, progressive growth failure from infancy, chromosomal anomaly
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turners syndrome
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what are endocrine presentations for turners syndrome
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short stature
gonadal failure obesity, HL, carb intolerance thyroid dysfunction |
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what are non endocrine presentation of turners
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high arched palate
prominent ears low hairline web neck hypoplastic nails cutaneious nevi lymphedema |
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what organs are involved in turners
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eye and hearing problems
prominent left sided heart disease** HTN, renal and GI disorders borderline MR |
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this has same features of turners syndrome but not as many symptoms. Classic: radial shortened, ulna displaced, deformed arms
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Leri - Weill Dyschonrosteriosis - no lymphedema, cardiac defects
will see cubitus valgus, short forearms, made lung deformity - radial short, high arched palate |
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this is an autosomal dominant condition that presents with turners syndrome like findings - in contrast will have right sided HF and in men
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noonan syndrome
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this is a syndrome with precocious puberty, delayed closure of fontanels, delayed bone age, short and curved in 5th finger, IUGR, post natal growth failure, frontal bossing, small angular facies, very skinny
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russell-silver syndrome
very petite, monitor growth |
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this is a 15p deficiency, short, hypotonia, FTT, progressive obesity will not stop eating, GH deficiency, congenital impairment
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prader-willi syndrome
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features: webbing of neck, low posterior hairline, ptosis, cubits valgus, malformed ears, cardiac abnormalities, 50% MR, right sided heart failure
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noonan syndrom
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this is hypotonia, FTT, hyperphagia, progressive obesity, short stature, hypothalamic dysfunction, GH def, increased aggression, almond shaped eyes
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prader-willi
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this is IUGR, birth weight <2 SD, 10% fail to catch up at 2 years old
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small for gestation age
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what are cause of SGA
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maternal size and small uterus
multiple fetuses birth order -first born maternal habits - smoking, ETOH, drugs increased maternal age |
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this is growth failure in childhood - significant short stature >2 SD
do not know why, do not match parents, normal GH tests |
idiopathic short stature
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when do you refer to endo for short stature
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height >2 SD
growth less than 2.5 per years, still in last years clothes unusual short family familial short stature dysmorphic features abnormal labs |
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what should you include in the referral to endo
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ht and wt, HC
all ht and wts previous illness PE findings medication all lab results all radiological results left wrist X-ray - send film |
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what are SE of GH therapy
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DM and insulin resistence
thyroid disorders acute pancreatitis liver abnormalitis benign ICH prepubertal gynacomastia MS problems GH antibody formation gonadal dysfunction leukemia LT cancer risk behavior changes OSA |
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how is GH administered
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injection daily, until epiphysis close. Will just help with genetic potential will not be super tall
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what are the most common SE of GH therapy
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edema
athralgia myalgia parasthesias carpel tunnel - bc of edema, press on nerves |
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what are some differential diagnoses for short stature
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skeletal dysplagia
chromosomal abnormalities - turner, noonan, prader-willi, down, IUGR Fetal infection - ETOH, drugs, impaired nutrition genetic |
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what are secondary differential diagnoses for short stature
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congenital anomalies
renal - polycystic, RTA, cardiac - PDA, VSD, TOF pulmonary - cystic fibrosis chronic infection meds - steriods metabolic disorders endocrine - GH def, hypothyroid |
