11.2 Growth Disorders Flashcards
baseline Ix for short stature?
- skeletal bone age (left hand and wrist)
- karyotype
- systemic screen: FBE, ESR, UEC, LFT, TFT, Ca, Phos, coeliac, urine MCS, IGF-1
biochemical dx of growth deficiency?
peak (after stimulation) of <10mU/L
how tall in untreated GH deficiency?
males 140cm
Females 130cm
when to refer/investigate height for severe?
- more than 3SD below mean
- more than 6cm below 3rd centile
- positive screening tests
when to refer for less severe growth ?
is height is 2-3 SD below or under 3rd centile
- systemic screen-NAD
- observe for 6/12 months
- if growth rate <25p refer
- if >25p, monitor
Bone age useful how?
- severity of growth problem
- remaining growth potential
- height prognosis
- estimated adult height calculation
eligibility criteria in australia?
-<1st percentile
-biochem growth hormone deficiency
-
bone ages that will exclude growth hormone use?
girls: 13.5
boys 15.5
any girl with unexplained short stature, no signs…. should consider?
- turner syndrome
- do a karyotype
- can end up 20cm shorter
Turner Syndrome at diagnosis investigations:
- ECG, cardiac, ECHO, cardiac/aortic arch/MRI
- audiology
- risk for diabetes
what to watch out for in Turner’s Syndrome to investigate and monitor?
Cardiovascular malformations
-ECHOs
management of turner syndrome?
- GH as soon as possible
- pubertal induction
- maintain Ca intake
- audiology, ECHO
- transition to young adult clinic
puberty correlate better with what measurement?
bone age
basic screens for tall stature?
- bone age
- karyotype
- IGF-a, random GH
- TFT
- urine
- echo
options for height limitation?
- avoid if possible
- high dose testosterone
- high dose oestrogen
