Growth

Question 1

When, relative to menarche, does the peak growth rate for girls occur?

Answer 1

Prior to it… He said typically at menarche girls have about 2 inches in height left.

Question 2

Formula for expected height based on parents’ heights?

Answer 2

Boys: [(M+F) + 5] / 2
Girls: [M+F) - 5] / 2
(I’m assuming this is in inches?)

Question 3

2 non-pathological reasons a 13 year old might be shorter than expected?

Answer 3

Genetic short stature

Constitutional delay - i.e. “late bloomer”

Question 4

Almost every chromosomal abnormality is associated with short growth, but which one do you look out for that really starts to show up around puberty?

Answer 4

Turner syndrome

Question 5

Can psychosocial deprivation impair growth?

Answer 5

Yes, independently of nutrition.

Question 6

3 endocrine disorders that can cause altered growth rate?

Answer 6

Hypothyroidism
Excessive steroids
GH deficiency

Question 7

What does a delayed (overly young-looking) bone age mean, with regards to a person’s growth?

Answer 7

Either they’re a late bloomer, or there’s disease.

Question 8

7 things to measure in blood to assess growth problem?

Answer 8

CBC
ESR
Celiac
Chemistry (electrolytes, kidney/liver function)
Karyotype
Growth hormones (IGF-1, IGF-BP3)
TSH, free T4

Question 9

Review (and one new thing): How do you measure GH activity in serum?

Answer 9

IGF-1 and IGFBP-3

Question 10

What does a GH deficiency look like?

Answer 10

Slow growth velocity
Delayed bone age
Low IGF-1 and IGFBP-3
Failed GH provocative testing (I guess this means you can’t stimulate GH release)

Question 11

Are boys different from girls in utero, hormonally?

As infants?

Answer 11

In utero: Yes, huge hormonal differences.

In infancy: Nope, should be the same.

Question 12

What’s important to know about 17-alpha-hydroxyprogesterone?

Answer 12

If elevated, it’s a sign of CAH (the most common form - a defect in 21 hydroxylase)

Question 13

Important: Testicular enlargement before what age is abnormal?
After what age is no testicular enlargement abnormal?

Answer 13

Before 9 years - abnormal.

After 14 years - abnormal.

Question 14

Important: Breast development before what age is abnormal?

After what age is no breast development abnormal?

Answer 14

Before 8 years - abnormal.

After 13 years - abnormal

Question 15

3 causes of central precocious puberty?

Answer 15

Idiopathic
CNS pathology (?)
Hamartoma

Question 16

3 peripheral causes of precocious puberty?

Answer 16

Ovarian cysts.
McCune Albright Syndrome (Cafe-ole spots, bone cysts, precocious puberty).
Exogenous steroid exposure.

Question 17

Treatment for precocious puberty?

Answer 17

GnRH agonists (suppresses LH and FSH)
Leuproline (Lupron)
Histrelin implant
-Most of the time, one doesn’t treat it, though.

Question 18

What’s Tanner stage 1?

Answer 18

No development at all.

Question 19

What’s Tanner stage 4 for breast development?

Answer 19

Areola is raised: “Mountain on mountain.”

often coincides with menarche, though the processes aren’t directly related

Question 20

What’s Tanner stage 4 for pubic hair?

Answer 20

Hair goes up to the belly button.

Fun fact: Belly button lint is believed to be largely due to underwear lint migrating up the hair trail to the navel.

Question 21

Why screen infants for hypothyroidism?

Answer 21

Because congenital hypothyroidism will cause severe mental retardation if untreated.

Question 22

How can treatment completely prevent the negative effects of congenital hypothyroidism?

Answer 22

Because before birth, infant is getting thyroid hormones from mom across the placenta. If replaced starting at birth, the baby will never be deficient in them.

Question 23

One anatomic anomaly that you might find in congenital hypothyroidism?

Answer 23

Lingual thyroid - due to the gland failing to migrate (through the foramen cecum).