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Flashcards in Growth Deck (19):
1

How do you calculate genetic expectations of growth based on parents?

(M+F +/-5) / 2

2

When is peak growth?

11.5 years old for girls
13.5 years old for boys

3

Genetic expectations of height are based on...(3)

Mid parental height
Familial timing of puberty and growth
Ethnicity

4

What is GH physiology?

GHRH from hypothalamus-->GH from anterior pituitary-->IGF-1 from liver-->Bone resorption and growth

5

What categories impact normal growth? (6)

Endocrine disorders (hypothyroidism, excessive steroids, GH deficiency)
GI (malnutrition, malabsorption, IBD, celiac disease)
SGA/IUGR
Systemic disorders (pulm, immuno, cardiac, hematological, med-related)
Psychosocial deprivation: neglect due to lack of nurturing/nutrition
Genetic disorders (Turner, Down syndrome, skeletal dysplasia, chromosomal disorders, Prader-Willi, Noonan, SHOX defect)

6

What is growth pattern of endocrine disorders?

Gain weight but grow slowly

7

How do you evaluate growth via X-ray?

Look at bone age-->fusing...are they late bloomer or just short?

8

What are things you look for in blood analysis?

CBC, ESR (Krohns?), celiac screen, chemistry, karyotype (for girls), growth factors (IGF1), TSH/free T4

9

Diagnosis of GH Deficiency (6)

History of risk factors (midline defects, malformations)
Poor growth velocity, Delayed bone age
Low IGF1, Failed GH provocative testing (glucose)
MRI of pituitary/hypothalamus

10

Growth Key Points

Growth reflects overall health
Anticipating growth patterns in a family
Peak growth rates in boys vs. girls
Tall/short stature is not due to GH
Poor growth vs. short stature
Features of Turner's
Workup for poor growth

11

Neonatal puberty issues (4)

Breast enlargement
Galactorrhea
Uterine bleeding
Genitalia concerns

12

Early Puberty Development: What are signs of androgens (4)

DHEA/Androstenedione/testosterone

Pubic hair
Body odor
Voice/acne
Growth surge

13

Early puberty development: what are signs of estrogen? (2)

Breast development
Growth surge

14

Onset of puberty: breast (consider race)

African American: 6% by age 6; mean by 8.9
Caucasian: 5% by age 7; mean by age 10

15

Onset of puberty: menarche (racial difference)

A.A: 12.16
Caucasian: 12.88

16

What are causes of precocious puberty?
Central (3) and peripheral (3)

Central precocity: idiopathic, CNS pathology, hamartoma

Peripheral: ovarian cysts, McCune-Albright, exogenous

17

Treatment of Precocious Puberty (4)

Lupron: monthly injection to halt puberty
Histrelin: subQ arm implant
Androgen blockers/Androgen receptor inhibitors:

18

Congenital hypothyroidism: Diagnosis and prognosis

Incidence=1/4000
Detected via state screening
Prognosis is excellent!

19

Congenital hypothyroidism: treatment

Thyroxin