10/19- Growth and Growth Disorders in Children Flashcards
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
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
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
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
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
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
What non-endocrine disorders would cause these growth patterns?
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
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
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
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
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
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
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
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
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
