Endo: Worrisome Growth 1

Question 1

Compare how we measure kids’ height if less than 2 yo and how we measure kids’ height if over 20 yo

Answer 1

• Less than 2 yo: measure lying down
• Over 2 yo: measure standing up

*This may produce a seeming decrease in height at 2 yo, b/c little kids can’t stand up straight

Question 2

Define short stature (3)

Answer 2

• Height that is more than 2 SD below mean
• Height that is 3rd percentile or less
• Height that is more than 3.5 inches below midparental target height

Question 3

How do you calculate midparental height?

What is a child’s expected height?

Answer 3

Midparental height = [Mom height + Dad height +/- 5]/2

*Add 5 for son, Minus 5 for daughter

Expected height is midparental height +/- 3.5 inches

Question 4

Define abnormal growth velocity on a growth chart

Answer 4

Abnormal growth velocity = crossing two major centile lines on the growth chart

Question 5

Normal growth velocity typically indicates that there is _______________

Answer 5

Normal growth velocity typically indicates that there is no pathology

Question 6

How do we determine skeletal maturation/age?

What does this tell us?

Answer 6

• Assessed via L hand xray
• Skeletal age indicates the time until growth plate (epiphyseal) closure

Question 7

How does puberty onset correlate with bone age?

Answer 7

• Delayed onset puberty -> younger bone age
• Early onset puberty -> older bone age

Question 8

Define Familial Short Stature

Answer 8

Children who are short, but have normal growth velocity and height is within normal for parents’ heights

Question 9

Are kids with familial short stature born small or normal?

How does their growth progress over time?

Answer 9

Familial short stature

• Birth weight/length is normal
• Decrease in growth rate occurs btwn 6-18 mos

Question 10

What is a colloquial term for constitutional growth delay?

Describe the growth over time.

Answer 10

CGD = “late bloomer”

1. Growth deceleration occurs during first 2 years of life
2. Then, normal growth velocity along lower percentile curve
   
   • Bone age will be delayed here
3. Then, late puberty and growth spurt

Question 11

Describe the tx of constitutional growth delay (2)

Answer 11

• Reassurance
• Can give short course of testosterone to boys if bone age is over 11.5 yo
  
  • Does not affect final height, but gives a burst

Question 12

A growth chart shows weight plateauing before height.

Most likely cause?

Answer 12

If weight plateaus before height, it’s more likely a nutritional/GI issue

Question 13

Define Nutritional Growth Retardation

Answer 13

Linear growth stunting due to poor weight gain in children over 2 yo

Question 14

A growth chart shows plateauing height with normal or elevated weight.

What is the most likely cause? (system)

Answer 14

Endocrine problems cause height to be affected first

Question 15

T4 and TSH in Central Hypothyroidism

Answer 15

• Low T4
• Inappropriately normal TSH

Question 16

What would indicate that the short stature is reversible?

Answer 16

Low bone age

(eg. bone age of 8 yo, chronological age of 12 yo)

Question 17

Are endocrine causes of growth delay generally reversible or irreversible?

Answer 17

Reversible

Question 18

Describe the effect of GH on height and body composition

Answer 18

GH

• Promotes linear growth
• Increases muscle
• Decreases fat

Question 19

What is unique about GH deficiency compared to deficiency of other pituitary hormones?

Answer 19

GH can be an isolated deficiency, whereas most other pituitary hormones deficiencies don’t occur alone

Question 20

4 Signs of GH Deficiency

Answer 20

• Decreased muscle, increased truncal fat
• Small penis
• Large forehead with small face (skull keeps growing)
• Hypoglycemia as a newborn

Question 21

How do we evaluate GH Deficiency (3)?

Answer 21

• IGF-1 level
• Bone age
• Stimulation testing
  
  • clonidine, arginine, glucagon, L-dopa

Question 22

Define Turner Syndrome

Answer 22

Complete or partial absence of 1 of the X chromosomes (45 XO)

*Only occurs in girls

Question 23

What causes short stature in Turner’s?

Answer 23

Haploinsuffiency of SHOX (Short Height karyotype) gene

Question 24

Describe the growth pattern and bone age of Turner’s syndrome

Answer 24

• 2 growth plateaus (one before 2 yo, one around 6 yo)
• Bone age is decreased but not very much (not fully reversible)

Question 25

Tx for Turner Syndrome short stature

Answer 25

GH!

*This improves final height even though they’re not growth deficient

Question 26

Define Small for Gestational Age

Answer 26

Birth weight or length less than 2 SD below mean for gestational age

Question 27

Treatment for Small for Gestational Age?

Answer 27

GH is approved for SGA children who fail to have growth catch up by 2 yo

Question 28

In GH deficient children, are all bones equally affected?

Answer 28

YES.

Unlike achondroplasia, GH deficiency produces proportional short stature

Question 29

Name manifestations of Turner’s Syndrome

• CV (2)
• Renal (1)
• Repro (2)
• Neuro (2)

Answer 29

• CV: Bicuspid aortic valve, coarctation
• Renal: Horshoe kidney
• Repro: Ovarian insufficiency, amenorrhea
• Neuro: Otitis media, hearing loss

Question 30

ADR of Growth Hormone (2)

Answer 30

• Pseudotumor cerebri
• Slipped capital femoral epiphysis

Long-term effects unknown

Question 31

Name 4 body features seen in Turner’s syndrome

Answer 31

• Short
• Increased carrying angle at elbow
• Lymphadema (causing webbed neck)
• Small jaw or retrognathia

Question 32

Describe 2 possible growth patterns for Small for Gestational Age kids

Answer 32

• Most will have catch up to genetic potential by 2 yo
• Some kids remain short and do not have a delay in bone age (that’s what sets apart from late bloomer)