Growth as an Indicator of Health and Disease

Question 1

what is abnormal growth?

Answer 1

growth velocity abnormal
height > 2.5 S.D below mean or mid-parental height

Question 2

a radiographic determination of degree of epiphyseal closure, which correlates closely with pubertal stages

Answer 2

Bone Age

Question 3

what is considered a normal variant of short stature?

Answer 3

height and weight < 5th percentile with normal head circumference

think: genetic short stature; constitutional delay

Question 4

• Family history of short stature
• birth weight greather than 2.5kg
• height below 3rd percentile for chronological age
• growth curve parallel to, but below, the 3rd percentile
• predicted adult height below 3rd percentile
• no organic emotional cause for growth failure- normal annual growth rates or bone age
• normal pubertal onset and maturation

Answer 4

Familial short stature

Question 5

• family history of similar pattern of growth and puberty
• normal nutritional status and physical exam
• height at or below 3rd percentile for age, but normal annual growth rate
• delayed puberty, delayed bone age
• normal predicted adult height in context of family pattern
• no organic or emotional cause for growth failure

Answer 5

constitutional growth delay

Question 6

examples of pathologic short stature?

Answer 6

• failure to thrive
• intrauterine insult
• genetic syndromes
• endocrine disease

Question 7

• weight < height
• think problem with calories: poor intake, big caloric losses, hypermetabolic state

Answer 7

failure to thrive

Question 8

• the most common cause of growth failure in the world
• both weight and height are decreased

Answer 8

Malnutrition= failure to thrive

Question 9

a few chronic diseases that cause short stature

Answer 9

• celiac disease, inflammatory bowel disease
• congenital heart disease
• renal disease
• chronic severe anemia
• cystic fibrosis, bronchopulmonary dysplasia

Question 10

• Height < 5th percentile; weight less affected
• hypothyroidism, cushing syndrome, diabetes mellitus, sexual precocity, IGF deficiency or resistance, panhypopituitarism, isolated growth hormone deficiences

Answer 10

Endocrine disease and short stature

Question 11

height, weight and head circumference < 5th percentile

• intrauterine insult
• genetic syndrome

Answer 11

Fetal origins of short stature

Question 12

laboratory tests for growth?

Answer 12

• CBC and UA
• ESR
• serum elecrolyte and chemistries
• thyroid function studies (TSH and T4)
• karyotype in short girls
• additional tests as indicated by history, physical findings or abnormal lab test results

Question 13

drugs that impact growth adversely?

Answer 13

• methylphenidate (ritalin)
• adderall
• glucocorticoids- oral, parenteral, inhaled

Question 14

how do glucocorticoids impair growth?

Answer 14

• protein catabolism
• impaired collagen synthesis
• inhibited IGF-1 activity
• suppressed GH secretion
• reversibility with GH therapy