Flashcards in Puberty & Growth Deck (69)
From an endocrine perspective, why are visual changes so significant?
b/c when you have a hypothalamic tumor-->can put pressure on the optic chasm just ventral to it.
What stimulates GH release? What is the pathway after that?
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.
Is IGF-1 made anywhere other than the liver?
What is the most important IGF for a child's growth?
With children w/ fetal alcohol syndrome...you have problems w/ which hormone?
What is the growth rate in the prenatal period? When does it peak?
Peaks @ midgestation
Which hormones have a minor effect on prenatal growth? Which hormones have a major effect?
Minor effect: GH & T4
Major Effect: IGF-1 & maternal factors
In infancy & toddlerhood...how fast do you grow? What is the influence of GH & T4 @ that point?
Now, GH & T4 have a strong influence
In childhood, what is the usual growth rate? What are the things that affect this?
During puberty, what is the potential growth rate? What are the main effectors of this?
Up to 15 cm/ year
The peak growth year for the male happens @ what age?
13.5 on average
What are the normal factors that influence growth?
GI abnormalities can stunt
Which hormones mainly influence growth?
Which types of GI abnormalities could stunt growth?
Inflammatory Bowel Disease
What types of genetic things can influence growth?
What are some environmental stressors that can affect growth?
Fetal Alcohol Syndrome
ADD & meds
Without GI complaints, how can Celiac sometimes be diagnosed in children?
kids with short stature...not sufficiently absorbed.
So if you want your kid to be 6'5''can you just give them a bunch of growth hormone?
NO. It is about genetics. Not all about GH.
If the dad was a late bloomer...what does that mean to the height of the kid?
If son...probably will be a late bloomer.
If mom were late bloomer--daughter probably would be. Sometimes there is also some crossover.
How would ADD meds affect growth?
These are appetite suppressing drugs. This can stunt growth.
What is the equation for mid-parental height for females?
Predicted Height = [Maternal Height + (Parental Height - 13 cm)]/2
What is the equation for mid-parental height for males?
Predicted Height = [(Maternal Height + 13 cm) + Parental Height]/2
What variance off of the mid-parental height is worrisome?
11/2 standard deviations from the mid-parental height
**could be stunted growth or just a late bloomer
What is the average difference in the heights of men & women?
13 cm or about 6 inches
How do you deal w/ heights of parents & child on a growth chart?
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.
Which things are charted on a growth chart?
If someone is under severe distress, which is the last to be altered: height, weight, head circumference?
head circumference is the last to go...
What is the effect of hormone deficiencies on head circumference?
Doesn't affect it!
only brain development, neurological issues, genetic issues affect head circumference.
Bone age isn't reliable until which age?
3 years of age
If weight is more affected than height on the growth chart, then what is likely the cause of the problem?
If height is more affected than weight on the growth chart, then what is likely the cause of the problem?
With younger kids, what is the proper way to measure their height?
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.
With older kids, what is the proper way to measure their height?
Don't use a scale!
There is a metal wall-mounted stadiometer
Behind & feet should touch the wall. Chin up.
Take 3 times & average.
T/F There is only one growth chart that is used for children or adults.
There are different growth charts for different ethnicities & different conditions.
What is the most helpful determining factor w/ height potential?
What is constitutional delay of growth & puberty?
normal growth velocity
normal predicted mid-parental heigh
bone age 2 years behind
usu b/c of delayed puberty
What is the incidence of constitutional delay of growth & puberty in men & women?
When does puberty generally start in men & women? At which ages is it considered delayed if puberty doesn't begin?
Age 10 for women; Age 12 for men
**this bone age indicates the beginning of puberty usu...
No puberty by age 13 for women; Age 14 for men
What is the progression of signs of puberty in females? In males?
Increase in testicular volume (4-5cc)
When might you think: this kid is experiencing short stature b/c of meds, GI, syndromes, endocrine issues or something?
When growth velocity is abnormal, or the predicted height is abnormal.
What are 4 syndromes that you sometimes have to consider for short stature?
What are some endocrine issues that could cause a short stature?
Growth Hormone Deficiency
What is the most common isolated pituitary hormone deficiency?
What are the effects that you see in GH deficiency?
Low IGF-1 & BP-3
Slow Growth Velocity
Bone Age Delay
What are other common isolated pituitary hormone deficiencies?
Which hormones control blood sugar in a growing kid?
What are 3 things that might indicate that you have a pituitary problem, specifically hypopituitarism?
If IGF-1 is low & BP-3 is fine...what are we thinking?
The kid is probably fine, probably just a little stressed.
What is a single central incisor & midline facial hypoplasia indicative of?
What causes diabetes insipidus?
lack of ADH, secreted by the posterior pituitary gland.
What are the signs/symptoms of hypopituitarism?
changes in appetite
single central incisor
Low Free T4 w/ normal TSH
Low IGF-1, BP-3
If you have a low free T4...how can you differentiate b/w hypothyroidism & hypopituitarism?
Hypothyroidism: Low Free T4 & Super High TSH
Hypopituiarism: Low Free T4 & Slightly Elevated TSH (it is trying to compensate).
With any chromosomal abnormalities...what do you have a higher chance of?
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?
95% fetuses spontaneously aborted
Should consider w/ any short female.
A Turner's syndrome patient with more Xs will exhibit what characteristic?
She will be taller.
What are major signs of Turner's Syndrome?
Cardiac Problems: coarctation of the aorta, aortic dilation, bicuspid aortic valve
Renal Problems: Horseshoe kidneys, duplicated collecting system, agenesis
What are the signs & symptoms of Russell-Silver Syndrome?
Failure to Thrive
What's the deal w/ Noonan's Syndrome?
You get right-sided cardiac defects
low set ears
**male turner's syndrome
**females can also get it.
What is the treatment for Russell-Silver Syndrome?
a lot of nutrition & sometimes GH
What's the deal w/ Prader-Willis Syndrome?
failure to thrive
hypotonia as an infant
excessive weight gain-->sometimes extreme obesity
Type II Diabetes
Would GH be a good treatment plan for someone with Prader-Willis syndrome?
No, would exacerbate the problem.
While Cushing's syndrome is very rare, what is the most common cause of these symptoms?
exogenous steroid use
What are the signs/symptoms of Cushing's syndrome?
Rapid Weight Gain: stretch marks (striae), buffalo hump
What are some tests that should be done if you suspect Cushing's Syndrome?
24 hour free urine cortisol
Dexamethasone suppression test
What is an example of an oral steroid? What is an example of an inhaled steroid?
Inhaled: glucocorticoids for asthma treatment
What are some good reasons to refer out a patient to an endocrine specialist?
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.
What are some syndromes/diseases that can cause an abnormally tall stature?
What are 2 endocrine problems that could cause abnormally tall stature?
GH secreting tumor