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Block 3; Week 7 > Puberty & Growth > Flashcards

Puberty & Growth Flashcards

1
Q

From an endocrine perspective, why are visual changes so significant?

A

b/c when you have a hypothalamic tumor–>can put pressure on the optic chasm just ventral to it.

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2
Q

What stimulates GH release? What is the pathway after that?

A

GHRH stimulates GH release from the pituitary gland. GH goes to the liver. It releases IGF-1. This causes bone growth & muscle growth & inhibits further GH release.

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3
Q

Is IGF-1 made anywhere other than the liver?

A

Not really…

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4
Q

What is the most important IGF for a child’s growth?

A

IGF-BP3

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5
Q

With children w/ fetal alcohol syndrome…you have problems w/ which hormone?

A

GH

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6
Q

What is the growth rate in the prenatal period? When does it peak?

A

1.2-2.5 cm/week

Peaks @ midgestation

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7
Q

Which hormones have a minor effect on prenatal growth? Which hormones have a major effect?

A

Minor effect: GH & T4

Major Effect: IGF-1 & maternal factors

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8
Q

In infancy & toddlerhood…how fast do you grow? What is the influence of GH & T4 @ that point?

A

15-25 cm/year

Now, GH & T4 have a strong influence

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9
Q

In childhood, what is the usual growth rate? What are the things that affect this?

A

5-7 cm/year
hormones
genetics
nutrition

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10
Q

During puberty, what is the potential growth rate? What are the main effectors of this?

A

Up to 15 cm/ year

HORMONES

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11
Q

The peak growth year for the male happens @ what age?

A

13.5 on average

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12
Q

What are the normal factors that influence growth?

A 
Hormones
GI abnormalities can stunt
Genetics
Nutrition
Environment
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13
Q

Which hormones mainly influence growth?

A

GH
thyroid hormones
cortisol
pubertal hormones

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14
Q

Which types of GI abnormalities could stunt growth?

A

Celiac Disease
Inflammatory Bowel Disease
Pancreatic Insufficiency

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15
Q

What types of genetic things can influence growth?

A

Parents’ height

Parents’ puberty

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16
Q

What are some environmental stressors that can affect growth?

A 
Fetal Alcohol Syndrome
drug exposure
ADD & meds
Steroids
Stress
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17
Q

Without GI complaints, how can Celiac sometimes be diagnosed in children?

A

kids with short stature…not sufficiently absorbed.

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18
Q

So if you want your kid to be 6’5’‘can you just give them a bunch of growth hormone?

A

NO. It is about genetics. Not all about GH.

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19
Q

If the dad was a late bloomer…what does that mean to the height of the kid?

A

If son…probably will be a late bloomer.

If mom were late bloomer–daughter probably would be. Sometimes there is also some crossover.

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20
Q

How would ADD meds affect growth?

A

These are appetite suppressing drugs. This can stunt growth.

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21
Q

What is the equation for mid-parental height for females?

A

Predicted Height = [Maternal Height + (Parental Height - 13 cm)]/2

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22
Q

What is the equation for mid-parental height for males?

A

Predicted Height = [(Maternal Height + 13 cm) + Parental Height]/2

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23
Q

What variance off of the mid-parental height is worrisome?

A

11/2 standard deviations from the mid-parental height

**could be stunted growth or just a late bloomer

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24
Q

What is the average difference in the heights of men & women?

A

13 cm or about 6 inches

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25
Q

How do you deal w/ heights of parents & child on a growth chart?

A

If it is a boy…
Plot mom’s height + 13 cm on the chart. Determine the percentile: maybe 70th.
Plot dad’s height on the chart. Determine the percentile: maybe 90th.
Take the average.
1-1.5 standard deviations from this is the potential.

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26
Q

Which things are charted on a growth chart?

A

Height
Weight
Head Circumference

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27
Q

If someone is under severe distress, which is the last to be altered: height, weight, head circumference?

A

head circumference is the last to go…

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28
Q

What is the effect of hormone deficiencies on head circumference?

A

Doesn’t affect it!

only brain development, neurological issues, genetic issues affect head circumference.

29
Q

Bone age isn’t reliable until which age?

A

3 years of age

30
Q

If weight is more affected than height on the growth chart, then what is likely the cause of the problem?

A

GI/nutritional

OR renal/metabolic

31
Q

If height is more affected than weight on the growth chart, then what is likely the cause of the problem?

A

Endocrine

OR renal/metabolic

32
Q

With younger kids, what is the proper way to measure their height?

A

By having them lay down…put them in this contraption w/ metal pieces on both sides. Requires 2 people to hold them down.
Do 3 times & take average.

33
Q

With older kids, what is the proper way to measure their height?

A

Don’t use a scale!
There is a metal wall-mounted stadiometer
Behind & feet should touch the wall. Chin up.
Take 3 times & average.

34
Q

T/F There is only one growth chart that is used for children or adults.

A

FALSE

There are different growth charts for different ethnicities & different conditions.

35
Q

What is the most helpful determining factor w/ height potential?

A

bone age

36
Q

What is constitutional delay of growth & puberty?

A 
short stature
normal growth velocity
normal predicted mid-parental heigh
bone age 2 years behind
usu b/c of delayed puberty
37
Q

What is the incidence of constitutional delay of growth & puberty in men & women?

A

Men: 1/75000
Women: 1/50000

38
Q

When does puberty generally start in men & women? At which ages is it considered delayed if puberty doesn’t begin?

A

Usually Starts:
Age 10 for women; Age 12 for men
**this bone age indicates the beginning of puberty usu…
Delayed if:
No puberty by age 13 for women; Age 14 for men

39
Q

What is the progression of signs of puberty in females? In males?

A

Females:
Moodiness
Breast Growth
Pubic Hair

Males:
Increase in testicular volume (4-5cc)
Pubic Hair

40
Q

When might you think: this kid is experiencing short stature b/c of meds, GI, syndromes, endocrine issues or something?

A

When growth velocity is abnormal, or the predicted height is abnormal.

41
Q

What are 4 syndromes that you sometimes have to consider for short stature?

A

Turner
Noonan
Russell-Silver
Cushing’s Syndrome

42
Q

What are some endocrine issues that could cause a short stature?

A 
Hypothyroidism
Growth Hormone Deficiency
Adrenal Insufficiency
Adrenal Hyperplasia
Hypopituitarism
LH/FSH Deficiencies
Kallman's
43
Q

What is the most common isolated pituitary hormone deficiency?

A

GH

44
Q

What are the effects that you see in GH deficiency?

A 
Low IGF-1 & BP-3
Slow Growth Velocity
Bone Age Delay
Hypoglycemia
Fatigue
Slow Mentation
45
Q

What are other common isolated pituitary hormone deficiencies?

A

LH

ACTH

46
Q

Which hormones control blood sugar in a growing kid?

A

GH

Cortisol

47
Q

What are 3 things that might indicate that you have a pituitary problem, specifically hypopituitarism?

A

Microphallus
Jaundice
Hypoglycemia

48
Q

If IGF-1 is low & BP-3 is fine…what are we thinking?

A

The kid is probably fine, probably just a little stressed.

49
Q

What is a single central incisor & midline facial hypoplasia indicative of?

A

Hypopituitarism.

50
Q

What causes diabetes insipidus?

A

lack of ADH, secreted by the posterior pituitary gland.

51
Q

What are the signs/symptoms of hypopituitarism?

A 
neonatal hypoglycemia
jaundice
microphallus
poor growth
delayed puberty
fatigue
constipation
polyuria
polydipsia
developmental delay
changes in appetite
sleeping problems
Diabetes Insipidus
septo-optic dysplasia
midline defects
single central incisor
Low Free T4 w/ normal TSH
Low IGF-1, BP-3
52
Q

If you have a low free T4…how can you differentiate b/w hypothyroidism & hypopituitarism?

A

Hypothyroidism: Low Free T4 & Super High TSH
Hypopituiarism: Low Free T4 & Slightly Elevated TSH (it is trying to compensate).

53
Q

With any chromosomal abnormalities…what do you have a higher chance of?

A

Celiac

Hypothyroidism

54
Q

What is the incidence of Turner’s syndrome? What percentage of fetuses w/ Turner’s syndrome are spontaneously aborted? When should you consider Turner’s?

A

1/25000
95% fetuses spontaneously aborted

Should consider w/ any short female.

55
Q

A Turner’s syndrome patient with more Xs will exhibit what characteristic?

A

She will be taller.

56
Q

What are major signs of Turner’s Syndrome?

A

Short Stature
Cardiac Problems: coarctation of the aorta, aortic dilation, bicuspid aortic valve
Renal Problems: Horseshoe kidneys, duplicated collecting system, agenesis
Hypothyroidism
Celiac Disease
Diabetes
Constant UTIs

57
Q

What are the signs & symptoms of Russell-Silver Syndrome?

A 
Short Stature
Macrocephaly
Micrognathia
Asymmetric Limbs
Precocious Puberty
Scoliosis
Failure to Thrive
Infantile Hypoglycemia
Triangular Face
Large Forehead
Tiny Mouth
58
Q

What’s the deal w/ Noonan’s Syndrome?

A 
You get right-sided cardiac defects
neck webbing 
hypogonadism
low set ears
**male turner's syndrome
**females can also get it.
59
Q

What is the treatment for Russell-Silver Syndrome?

A

a lot of nutrition & sometimes GH

60
Q

What’s the deal w/ Prader-Willis Syndrome?

A 
failure to thrive
hypotonia as an infant
excessive weight gain-->sometimes extreme obesity
Type II Diabetes
Almond-shaped eyes
Pulmonary HTN
61
Q

Would GH be a good treatment plan for someone with Prader-Willis syndrome?

A

No, would exacerbate the problem.

62
Q

While Cushing’s syndrome is very rare, what is the most common cause of these symptoms?

A

exogenous steroid use

63
Q

What are the signs/symptoms of Cushing’s syndrome?

A

Short Stature
Rapid Weight Gain: stretch marks (striae), buffalo hump
Hypertension
Delayed Puberty

64
Q

What are some tests that should be done if you suspect Cushing’s Syndrome?

A 
Salivary Cortisol
AM Cortisol
ACTH
24 hour free urine cortisol
Dexamethasone suppression test
65
Q

What is an example of an oral steroid? What is an example of an inhaled steroid?

A

Oral: prednisone
Inhaled: glucocorticoids for asthma treatment

66
Q

What are some good reasons to refer out a patient to an endocrine specialist?

A

Signs of pituitary deficiency: microphallus, jaundice, neonatal hypoglycemia
Growth Hormone Deficiency
Abnormal Body Proportion
Child farther than 1.5 standard deviations from their predicted height…
Abnormally fast or slow growth
Persistent growth velocity less than 10th percentile & greater than 95th percentile.

67
Q

What are some syndromes/diseases that can cause an abnormally tall stature?

A

Marfan’s
Soto’s
Klinefelter’s

68
Q

What are 2 endocrine problems that could cause abnormally tall stature?

A

GH secreting tumor

Hyperthyroidism

69
Q

What does exogenous obesity do to growth?

A

It makes you grow faster & taller & hit puberty earlier.

Sometimes, actually, boys w/ exogenous obesity hit puberty later.

Block 3; Week 7 (6 decks)

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