growth puberty and adolescents Flashcards
standard deviation is the variability, if in to 1 s.d, this accounts for __%, __% is between +/- 2 s.d,
68
95
2 factors which deermine if childs growth is normal
measurements within normal range
rate of growth is within normal range
trends in growth in last 30 years is that there has been a shift to the __ with a longer tail, increasing __ __, and a similar upward trend with height
right
sev obesity
<2yrs, height measured with ___, >2yrs measured with __
length board/mat
t piece/stadiometer
in girls, puberty occurs when secretion of ___ releasing hormone (GnRH), by the __, incr so that pulsatile secretion of __ incr, resulting in sufficient sex steroid production to result in ___ __ development.
gonadotrophins
hypothalamus
LH
secondary sexual
in boys, LH stimulates __ cells to produce testosterone, inducing secondary sexual development.
FSH binds to receptors on __ cells, enhancing spermatogenesis. Testosterone modulates __ secretion. Sertoli cells produce inhibin B to __ FSH secretion. Sex hormone-binding globulin (SHBG) falls so that free androgen levels __
leydig
sertoli
LH
stop (-ve feedback)
rise
in girls, LH stimulates proliferation of follicular and __ cells. During F.phase, LH induces __ secretion by theca cells
FSH induces prooliferation of __ cell,s incr expression of LH enhances aromatase activity so that androstenedione is converted to ___(E2). (also incr progesterone production)
Oestradiol acts on FSH receptors on granulosa cells, causing proliferation of __ cells and inducing 2ndary sexual development.
thecal
androgen
thecal
oestradiol
granulosa
in both sexes, GH and __ secretion are enahnced because of incr levels of sex steroids and __
IGF-1
insulin
True central precocious puberty is normal pubertal development occuring abnormally early. when indicated in each sex
girls <8
boys <9
pubertal delay is absence of 2ndary sexual development in a girl aged __ ad a boy aged __
girl = 13
boy=14
initial approach to possible growth problem, state what should be discussed in history and 3 things to consider in examination
history
- ICE
- birth
- PMH
- puberal symptoms
- FH - parents heights and puberty
Exam
- height, weight, height velocity,
- signs of pathology
- pubertal status
investigations for growth problems
bloods (Gonadotrophins, Testosterone/Oestradiol, Thyroid, Karyotype)
bone age
dynamic function tests
MRI brain
USSS uterus
genetic short stature compared to constitutional growth delay
genetic short stature, healthy child inherited short stature from parents, no underlying endocrine abnormality and normal bone age
growth delay - late maturation causing short stature, delayed malnutrition and bone age
