10/19- Growth and Growth Disorders in Children Flashcards Preview

MS2 Endocrine > 10/19- Growth and Growth Disorders in Children > Flashcards

Flashcards in 10/19- Growth and Growth Disorders in Children Deck (23):
1

What is normal growth in childhood (stats)?

- Standards set with mean heights for age and sex +/- 2 STDs

- Evaluate those >2 or under -2 SDs

- May not be a problem if out of norm

- Check growth rates!

- Evaluate birth: IUGR, SGA, AGA, LGA

2

Describe normal growth velocity?

- Growth highest right after birth

- Peak again in puberty

  • Growth rate is variable
  • Duration of growth spurt is variable
  • Growth rate rapidly declines at end of puberty

3

What is the average age onset puberty?

Girls: 10-11 yr average (range 8-13 yo)

- Further eval if no development by 13 yo in girls

Boys: 11-12 yr average (range 9-14 yo)

- Further evaluation if no development by 14 yo in boys

4

Describe delayed growth:

- Seen when

- More common in boys or girls

- What is delayed

- What other factors

- Usually seen by 2 yo

- More common in boys

Delays:

- Height, weight and bone age lag behind

- Pubertal development lags behind

Factors:

- Positive family history

- Height prediction is normal 

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5

Describe Familial Short Stature

- Family characteristics

- Growth velocity

- Development

- Parents usually short

- Normal growth velocity

- Normal development

- Bone age = Chronological age

- Occasionally parents with genetic cause short stature too 

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6

What are some non-endocrine causes of poor growth?

- Malnutrition

- Psychological

- Gastrointestinal

  • Celiac disease
  • Inflammatory bowel disease
  • Malabsorption
  • Cystic fibrosis
  • Liver disease

- Diabetes mellitus (absorbing well, but losing much glucose in urine)

- Heart disease

- Respiratory disease

  • Cystic fibrosis (don't absorb fat well and have huge caloric demands)
  • Asthma

- Renal disease

  • Chronic renal failure
  • Dysplastic kidneys
  • RTA

- Hematologic/oncologic diseases

  • Cancer (methotrexate/other treatments play a part)
  • Anemias
  • Bleeding disorders

- Rheumatologic disorders

7

What non-endocrine disorders would cause these growth patterns? 

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Top line: inflammatory bowel disease

- Child typically grows well to a point

- Cramping, diarrhea, other symptoms may start later

Middle: renal disease

Bottom line: IUGR, Syndromes

- Start small; have small number of cells to start 

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8

What are some endocrine causes of poor growth?

- Hypothyroidism (her most common)

- Glucocorticoid excess

  • Endogenous (rare)
  • Exogenous (for cystic fibrosis, transplant recipients, bad asthma...)

- Hypopituitaris

- Precocious puberty

- Growth hormone deficiency/insensitivity

9

Describe congenital hypothyroidism

- Incidence

- Major cause of ___ if not treated early

- Due to what

- Signs

- Symptoms

- 1 per every 2500-4000 births

- Major cause of retardation if not treated early

- Due to: agenesis, ectopia, dyshormonogenesis

Signs:

- Big tongue

- Umbilical hernia

- Open fontanelle

Symptoms:

- Poor feeding

- Increased sleeping

- Lethargy

- Poor growth and weight gain

10

Describe acquired hypothyroidism

- Epidemiology

- Mechanism

- Signs

- Symptoms

- More in females

- Lymphocytic infiltration of gland

Signs:

- Usually enlarged gland

- Dry skin

- Constipation

- Hair abnormalities

Symptoms:

- Poor growth, weight gain

- Fatigue

- Poor concentration/school work

11

Describe hypercortisolism:

- Endogenous vs. exogenous

- Signs/symptoms

Endogenous is rare in childhood; exogenous may result from treatment:

- Asthma

- CF

- Cancer

- Arthritis

- Renal disease

- Autoimmune diseases

Signs/symptoms:

- Central obesity

- Thin limbs

- Striae

- Buffalo hump less common

- Hirsuitism

- Fatigue

- Increased appetite

12

Describe hypopituitarism

- Signs of congenital

- Causes of acquired

- Evaluate for what else

- First sign may be

- Treatment

Congenital may involve:

- Signs of hypothyroidism

- DI

- Poor growth

- Hypocortisolism

- Microphallus

Acquired may be caused by:

- Injury

- Surgery

- Infiltrative

Need to evaluate first for:

- Hypothyroidism

- Hypocortisolism

Hypoglycemia may be 1st sign

Tx: replace all hormones needed

13

Describe growth hormone deficiency

- Prevalence

- How to diagnose

- Signs/symptoms

- Relation to GFs

- Prevalence: 1 per 4-8,000

- Dx of exclusion

- Pay attention to both sexes

Signs/symptoms:

- Short, round, usually not thin

- Under 2-3 STD or poor growth velocity

Monitor GFs:

- IGF-1: more sign nutrition

- IGF BP3: best Seen in Hypopituitarism too

14

What is precocious puberty?

- Other symptoms

- Need to delineate what milestones/how to diagnose

- When to treat

- Child with puberty under 8 (F) or 9 (M)

- May be overgrown, obese

- Large early, short later

Diagnosis:

- Need to delineate thelarche (breast development), adrenarche (pubic/axillary hair), true precocity

- True precocity = increase in breast size for girl or increase in testicle size in boy

Treat if:

- Poor ht potential

- Psychological distress

15

How to evaluate growth?

- Get accurate measurements

- Measure more often in infancy

- Yearly after infancy

- Plot the data!

- Equal attention to both sexes

- Proper equipment

16

How to get accurate measurements for young kids?

- Measure supine 0-24 months

- Hold infants and toddlers in place

- Use stadiometer for older children

- Position child carefully

- Time of day can even make difference

17

What are signs of poor growth?

- Height < 3%

- Height well below height potential

- Slow growth velocity

- Crossing percentiles, esp. after 18 months

- Marked changes in growth pattern

18

What is short stature?

- Height SDs under 2 STD for age/sex

- 5% of normal children are under 5%

- Calculate mid-parental height

19

What are equations for mid-parental height?

Male:

[M ht(cm) + 13 cm + F ht(cm)]/2

Female:

[M ht(cm) - 13 cm + F ht(cm)]/2 Note: 13 cm ~ 5 in

20

What is included in growth history?

- Pregnancy-maternal health, Etoh, drugs, placental health

- Birth: IUGR, SGA, AGA, LGA

- Birth trauma or problems, hypoxia

- Congenital anomalies, syndromes

- Neonatal course

- General health-chronic illness

- Psychological health

- Growth: height, weight, growth rate

- Family history: mid-parental ht, sibs ht

- Sexual development-early or late?

21

What does the physical exam for growth disorders involve?

- Height, weight, growth velocity

- Tanner staging

- Syndromic features-webbed neck, body shape

  • Especially Turner's (45X): webbed neck, wide-carried arm
  • She likes to evaluate all likely short girls with karyotype to see if mild Turner's

- Upper/lower ratio

22

What does the diagnostic evaluation for growth disorders involve?

- T4, TSH

- Metabolic Panel

- Urinalysis

- CBC, sedimentation rate

- IGF-1, IGFBP-3

- Chromosomes

- Bone age

- MRI w/ attention to pituitary region

- Growth hormone stimulation testing

  • Exercise
  • Insulin
  • Arginine
  • L-dopa
  • Glucagon
  • Clonidine

23

What is treatment for growth disorder?

- Treat underlying cause first

- Optimize nutrition

- Try to lower steroids

- Hypothyroidism w/ synthetic thyroid

- Thyroid-8-10 mcg/kg in infants, 3-5 mcg/kg in children, 1-3 mcg/kg in adolescents

- Hypocortisolism w/HC in childhood

- HC at 6-8 mcg/m2/d

- DDAVP at dose to keep Na 135-155

- Lupron Depo-Ped for precocious puberty

- Tx GH deficiency early for hypoglycemia

  • GH tx is a long term commitment
  • GH is very expensive-$ 10-20,000/yr