Abnormal Growth in Peds Flashcards
(29 cards)
What factors are evaluated in Auxology?
Compare growth patterns with norms
Changes ifn height-wt-head circ
Genetic potential
Normal vs Pathological dev.
What is the normal growth pattern?
Predictable Progression
Pulsatile
Seasonal
What are the measurements that are factored into Auxology?
Weight-length-head circ
Growth Charts
-WHO children
What needs to be considered when taking a history in Auxology?
Weight-lenght-head circ at birth Prenatal history interval growth points past medical history Dietary history Devt History
What factors are considered in body proportions?
Upper seg to lower seg
Increased in turner syndrome, rickets and achondroplasia
Dec in marfan Synd
Arm span to height
What constitutes over/underweight in BMI?
Overweight = 85th-95th percentile
Obese= >95th %ile
Underweight
What constitutes Failure to thrive?
Weight
What is the most common underlying cause of Failure to thrive?
Insufficient Nurition Inad Intake Inad Abs Inc Urinary/intesinal loss Inc Requirements Ineffective Utilization
What is the difference between Wasting vs Stunting
Wasting: ###
Stunting: Normal at birth: Weight reduced but not height. later height lags, last head circ.
What Diagnostic Tests are used to evaluate Failure to thrive?
Labs: CBC, Urinalysis, BUN/Cr, Lead, LFTs Albumin/ALk phos, Ca and Phos if severe Imaging: Upper GI series Swallowing function Radionucleotide gastric emptying scans
What are the 5 Questions used in Eval of Tall Stature?
Height abn for Pop? >97.7th Growth abn rapid? -H/Ag dev up 2 major height %ile Growth within range of Fam? -Mid-parental ht Evidence of Accel Growth? -Adv Bone Age? Dysmorphic Features found? -Disorders or Syndromes?
How is mid parental height Calculated?
Girl: ((Fath-5in)+ Moth Ht)/2
Boy ((Mother+5in)+ Fath Ht)/2
Target Mid parental ht +/- 2 SD
What is the most common Cause of large for gestational age infants?
Maternal DM
What are more common Diseases of overgrowth in infancy?
Cerebral Gigantism
Beckwith-Wiedman Synd
What are the Endocrine Disorders that can cause Growth abnormalities?
Precocious Puberty GH excess Hypothyroidism Sex Hormone Deficiency or Insensitivity Familial Glucocorticoid Def
What are causes of Precocious Puberty?
Central GDPP -HT or Pit Peripheral GDIP -Congenital Adrenal HP -Testicular or Ovarian tumors -McCune Albright synd
What are features of kids with Precocious Puberty?
More in girls
Advanced Bone age
Early Epiphyseal closure
Tall child but short as adult
What are chaicteristics of a Pt with GH Excess?
Rare and Genetic Height >3-4 SD Normal Bone age Elevated IGF-1, IGFBP-3, Abn MRI Tx- Surgery, Rad or Meds
What are features of Hyperthyroidism?
Clinically similar to adults Diffuse Goiter Adv bone age Low TSH, High T3 and T4 Tx normalizes growth
What are the features of Sex hormone Deficiency or Insensitivity?
Def of Test or Estrogen Permanent Hypogonadism Delayed Skeletal maturation EunuchoidProportions -long legs -Red UL segment ratio Low sitting height
What are the features of Familial Glucocorticoid Deficiency
Rare 1^ adrenal insuff High ACTH and Low Cort -excessive adrenal androgens Hypoglycemia, seizures, and hyperpigmentation
What are the non-endocrine disorders that lead to Abnormal growth?
Exogenous Obesity Melanocortin-4 receptor mutation Klinefelter Synd 47XYY synd Marfan Homocysteineuria
What are features of Exogenous Obesity?
Tall, early onset pubery
Low GH prod
BMI >95th percentile
Genetic and Endo Obesity usually short
What are features of Melanocortin 4 receptor Mutation?
Most common Monogenic cause of Obesity
Hyperphagia, Hyperinsulinemia
Preserved Repro Function
