Short stature a Diagnostic approach
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1) Short stature is defined as a height more than 2 standard deviations below the average for age and sex. A thorough evaluation considers the child's growth pattern, growth velocity, bone age, medical history, and family history. 2) Basic evaluations include height, weight, bone age, and blood tests. Further testing may include thyroid function tests, serum IGF-1, karyotype, and morning LH/FSH if signs of precocious puberty are present. 3) Causes of short stature include genetic factors, malnutrition, endocrine disorders, chronic diseases, and idiopathic causes. Growth hormone therapy may be considered for growth hormone deficiency, Turner syndrome, and other conditions
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Evaluation of short stature
Family seeks medical attention for their short child. The document discusses evaluation of short stature including criteria for pathological short stature, factors regulating growth, assessment of growth including height measurements and bone age, common causes of short stature like constitutional delay of growth and puberty, primary growth hormone deficiency, and hypothyroidism. Evaluation of a short child involves history, physical exam, laboratory tests, and assessing height, parental heights, and bone age.
Approach to short stature
This document provides an overview on approaching short stature in children. It discusses defining short stature, the importance of accurate measurements and growth charts, common causes including familial, constitutional, and endocrine factors. The document outlines the assessment process including history, examination, and initial investigations. Key differentials like familial vs constitutional short stature and Turner vs Noonan syndrome are reviewed. Management focuses on treating underlying causes, nutrition, psychological support, and growth hormone therapy in select cases. Regular follow-up is emphasized as the main initial management step for short stature.
Approach to short stature 160614135523
This document provides an overview of the approach to evaluating and managing short stature in children. It discusses definitions of short stature, the importance of accurate measurements and growth charting, common causes of short stature including familial, constitutional, and endocrine-related factors. A history should inquire about perinatal factors, nutrition, family patterns, and chronic illnesses. A full examination can detect dysmorphic features or disproportion. Initial workup may include bone age, blood tests, and hormonal assays as indicated. Common causes like familial short stature and Turner syndrome are discussed in more detail. Management focuses on treating underlying causes, ensuring proper nutrition and follow-up, with growth hormone treatment considered for select cases.
SHORT STATURE
A 15-year-old male presents with concerns of short stature and delayed puberty. Differential diagnoses include gonadotrophin deficiency, gonadal failure, and constitutional delay of growth and puberty. Physical exam and bone age assessment support a diagnosis of constitutional delay of growth and puberty, which is a condition of temporary short stature and delayed puberty but normal expected progression and attainment of full adult height. Reassurance and monitoring are the typical management approach.
Short stature in children 2020
This document provides guidance on evaluating and managing short stature in children. It discusses evaluating a short child by taking a history including birth details, illnesses, nutrition, and parental heights. Physical examination involves measuring height, weight, body proportions, and examining parents. Growth charts are used to assess if a child's height is below standard deviations. Potential causes of short stature discussed include familial, constitutional growth delay, chronic diseases, psychosocial, chromosomal, genetic syndromes, and endocrine disorders. Initial investigations include blood tests and bone age x-ray. Advanced tests may include skeletal survey, karyotype, growth hormone stimulation. Management depends on the identified cause and may include counseling, disease treatment, hormone therapy.
Short stature
1. This document provides guidance on evaluating short stature in children. It outlines steps to determine if a child's height is abnormal, investigate potential underlying causes, and decide which tests are appropriate.
2. The first steps are to measure the child's height, weight, and proportions, then compare to growth charts and calculate midparental height. Bone age testing can indicate if growth is delayed or accelerated.
3. Potential causes of short stature discussed include familial, constitutional, endocrine, congenital, chronic disease, and metabolic factors. The document provides examples of diseases for each category.
4. Recommended initial investigations include basic blood tests. Further tests are tailored to the suspected condition and may
Short stature in children 2021
This document provides an overview of evaluating and managing short stature in children. It discusses evaluating a child's growth pattern, examining family history and performing physical exams. Key factors that can cause short stature are discussed, including familial, constitutional growth delay, chronic diseases, psychosocial, chromosomal, genetic syndromes and endocrine disorders. Investigations discussed include growth charts, bone age assessments, blood tests and other tests depending on symptoms. Management depends on the underlying cause, such as counseling for familial short stature, disease management for chronic illnesses, growth hormone therapy for deficiencies.
Short stature
This document provides information on short stature, including defining it as height below the third centile or more than 2 standard deviations below the median height for age and gender. It discusses assessing short stature by accurately measuring height, assessing height velocity, comparing to population norms and genetic potential. It also classifies short stature and discusses differential diagnosis, management, and approaching a case scenario.
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Evaluation of short stature
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Approach to short stature
This document provides an overview on approaching short stature in children. It discusses defining short stature, the importance of accurate measurements and growth charts, common causes including familial, constitutional, and endocrine factors. The document outlines the assessment process including history, examination, and initial investigations. Key differentials like familial vs constitutional short stature and Turner vs Noonan syndrome are reviewed. Management focuses on treating underlying causes, nutrition, psychological support, and growth hormone therapy in select cases. Regular follow-up is emphasized as the main initial management step for short stature.
Approach to short stature 160614135523
This document provides an overview of the approach to evaluating and managing short stature in children. It discusses definitions of short stature, the importance of accurate measurements and growth charting, common causes of short stature including familial, constitutional, and endocrine-related factors. A history should inquire about perinatal factors, nutrition, family patterns, and chronic illnesses. A full examination can detect dysmorphic features or disproportion. Initial workup may include bone age, blood tests, and hormonal assays as indicated. Common causes like familial short stature and Turner syndrome are discussed in more detail. Management focuses on treating underlying causes, ensuring proper nutrition and follow-up, with growth hormone treatment considered for select cases.
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A 15-year-old male presents with concerns of short stature and delayed puberty. Differential diagnoses include gonadotrophin deficiency, gonadal failure, and constitutional delay of growth and puberty. Physical exam and bone age assessment support a diagnosis of constitutional delay of growth and puberty, which is a condition of temporary short stature and delayed puberty but normal expected progression and attainment of full adult height. Reassurance and monitoring are the typical management approach.
Short stature in children 2020
This document provides guidance on evaluating and managing short stature in children. It discusses evaluating a short child by taking a history including birth details, illnesses, nutrition, and parental heights. Physical examination involves measuring height, weight, body proportions, and examining parents. Growth charts are used to assess if a child's height is below standard deviations. Potential causes of short stature discussed include familial, constitutional growth delay, chronic diseases, psychosocial, chromosomal, genetic syndromes, and endocrine disorders. Initial investigations include blood tests and bone age x-ray. Advanced tests may include skeletal survey, karyotype, growth hormone stimulation. Management depends on the identified cause and may include counseling, disease treatment, hormone therapy.
Short stature
1. This document provides guidance on evaluating short stature in children. It outlines steps to determine if a child's height is abnormal, investigate potential underlying causes, and decide which tests are appropriate.
2. The first steps are to measure the child's height, weight, and proportions, then compare to growth charts and calculate midparental height. Bone age testing can indicate if growth is delayed or accelerated.
3. Potential causes of short stature discussed include familial, constitutional, endocrine, congenital, chronic disease, and metabolic factors. The document provides examples of diseases for each category.
4. Recommended initial investigations include basic blood tests. Further tests are tailored to the suspected condition and may
Short stature in children 2021
This document provides an overview of evaluating and managing short stature in children. It discusses evaluating a child's growth pattern, examining family history and performing physical exams. Key factors that can cause short stature are discussed, including familial, constitutional growth delay, chronic diseases, psychosocial, chromosomal, genetic syndromes and endocrine disorders. Investigations discussed include growth charts, bone age assessments, blood tests and other tests depending on symptoms. Management depends on the underlying cause, such as counseling for familial short stature, disease management for chronic illnesses, growth hormone therapy for deficiencies.
Short stature
This document provides information on short stature, including defining it as height below the third centile or more than 2 standard deviations below the median height for age and gender. It discusses assessing short stature by accurately measuring height, assessing height velocity, comparing to population norms and genetic potential. It also classifies short stature and discusses differential diagnosis, management, and approaching a case scenario.
Basic approach on short stature in children
This document provides an overview of short stature, including definitions, types, diagnostic principles, causes, and management. It defines short stature as height below the 3rd percentile and discusses types such as familial short stature. Diagnosis involves accurate height measurements, bone age assessment, mid-parental height comparison, and medical investigations. Causes include growth hormone deficiency, Turner syndrome, and small size at birth. Management consists of dietary counseling, growth hormone injections, and limb lengthening procedures depending on the underlying cause.
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This document provides information on pediatric growth hormone deficiency. It discusses GH secretion and control, GH physiology, the metabolic effects of GH, and approaches to evaluating and diagnosing a child with short stature. Causes of GH deficiency include defects in the hypothalamus or pituitary gland due to genetic mutations, injuries, or tumors. GH stimulation tests are used to diagnose GH deficiency. Treatment involves recombinant human GH therapy to improve growth and development.
Short Stature.pptx
1. Short stature can be caused by familial, constitutional, or pathological factors. Familial short stature runs in families while constitutional short stature involves delayed puberty.
2. Pathological short stature can be disproportionate involving abnormal limb ratios, or proportionate involving prenatal issues like IUGR or postnatal diseases/nutritional disorders.
3. Evaluating a short child involves assessing growth charts, growth velocity, bone age, family history, and screening tests to classify the cause of short stature.
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This document discusses short stature in children, defining it as height below 2 standard deviations for age and gender. It outlines factors that can affect height, including nutrition, hormones, and intrauterine growth. Short stature is classified as dysmorphic, proportionate, or disproportionate. Evaluation involves medical history, physical exam, auxiliary tests like bone age and growth hormone stimulation, and considering familial, constitutional, nutritional, endocrine, and genetic causes. Management depends on the underlying etiology and may include counseling, dietary changes, surgery, hormone replacement, or growth hormone therapy.
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This document discusses the evaluation and management of short stature in a 5 year 8 month old boy brought by his parents for concerns about his growth. The boy has a history of chronic constipation since birth and poor appetite. On examination, he is below the 3rd percentile for height and has soft dysmorphism. Differential diagnoses discussed include gastrointestinal, renal, hematological, and endocrine causes. Growth hormone deficiency is evaluated in detail, including epidemiology, causes, clinical presentation, investigation involving growth hormone stimulation tests, and management with growth hormone replacement therapy. Complications of treatment and new therapies are also mentioned.
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1) Short stature can be caused by disease, disability, or social stigma and requires evaluation.
2) A child is considered short if their height is below the 3rd percentile or more than 2 standard deviations below the median height for their age and sex.
3) Approximately half of children with short stature have a physiological/familial cause, while the other half have a pathological cause like malnutrition, chronic illness, hormonal deficiencies, or genetic syndromes.
4) Evaluation of a child with short stature involves taking a thorough history, performing anthropometric measurements and growth chart analysis, conducting a physical exam, and ordering initial lab tests and bone age assessment.
Short stature
1. Short stature can be defined as a height more than 2 standard deviations below the mean height for age and gender.
2. Evaluation of a child with short stature includes assessing height, mid-parental height, bone age, basic lab tests, growth hormone stimulation tests, and IGF-1 and IGFBP-3 levels.
3. Causes of short stature include growth hormone deficiency, Turner syndrome, chronic renal insufficiency, and being small for gestational age. Growth hormone treatment dosages vary depending on the underlying cause.
Approach to hypoglycemia in infants and children
Some additional things to ask in the history:
- Family history of similar episodes or endocrine disorders
- Dietary history, including any changes in appetite/food intake
- Growth pattern and any slowing of growth
- Pubertal development
Some additional things to examine:
- Vital signs - check for signs of dehydration, shock
- Detailed physical exam looking for signs of other endocrine abnormalities
- Developmental assessment
- Nutritional status
Investigations to consider:
- Electrolytes, liver/renal function tests
- Cortisol, ACTH to check for primary adrenal insufficiency
- Thyroid function tests
- Growth hormone stimulation test
- Blood glucose curve/
Growth hormone deficiency states and growth hormone replacement therapy
Growth hormone deficiency can occur in children or adults. In children, it presents as short stature and delayed growth. In adults, non-specific symptoms include reduced energy, quality of life, and increased cardiovascular risk. Growth hormone deficiency is investigated through stimulation tests and IGF-1 levels and treated with recombinant human growth hormone via daily injections, with doses titrated based on response. Treatment aims to normalize growth in children and improve symptoms and quality of life in adults.
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Approach to short stature ppt.pptx
Approach to Short Stature
Dr Raheel Ahmed
FCPS in Paediatric Medicine
Children Hospital, Chanka Medical College, Larkana
Topics
Definition.
Etiology
Measurements.
Examination.
Investigations.
Management.
Take home message.
Who is short child?
Short stature is defined as height that is two standard deviations below the mean height for age and sex (less than the third percentile).
OR
more than two standard deviations below the mid-parental height.
Etiology
Proportionate Short Stature
1) Normal Variants:
i) Familial
ii) Constitutional Growth Delay
2) Prenatal Causes:
i) Intra-uterine Growth Restriction-
Placental causes, Infections, Teratogens
ii) Intra-uterine Infections
iii) Genetic Disorders (Chromosomal
& Metabolic Disorders)
Postnatal Causes:
i) Undernutrition
ii) Chronic Systemic Illness
- Cardiopulmonary: CHD, Chronic Asthma,
Cystic Fibrosis
- Renal: RTA, CRF, Steroid dependent
Nephrotic Syndrome
- GI and Hepatic: Malabsorption, IBD, chronic
liver disease
- Chronic Severe Infections
- Hematological : Thalassemia, Sickle cell
anemia
iii) Psychosocial Short Stature
(emotional deprivation)
iv) Endocrine Causes:
- Growth Hormone Deficiency/ insensitivity
- Hypothyroidism
- hypopituitrism
- Diabetes Mellitus
- Cushing Syndrome
- Pseudohypoparathyroidism
- Precocious/ delayed puberty
Disproportionate Short Stature
1) With Short Limbs:
Achondroplasia,
Hypochondroplasia,
Chondrodysplasia punctata,
Chondroectodermal Dysplasia,
Diastrophic dysplasia,
Metaphyseal Chondrodysplasia
Osteogenesis Imperfecta,
Refractory Rickets
2) With Short Trunk:
Spondyloepiphyseal dysplasia,
Mucolipidosis
Mucopolysaccharidosis
Mid Parental Height
TCR
Calculated by MPH +-10
How to measure upper and lower segments?
You should measure the upper segment( US ) then by using the total height you will obtain LS.
Upper segment is the sitting height.
Disproportionate short statue with short LS:-
Achondroplesia
Osteogenesis imperfecta.
Refractory rickets.
Disproportionate short stature with short US:-
Spondyloepiphysial dysplasia.
Mucopolysaccharidosis.
Growth velocity
0-1 year : 25cm/year
1-2 year: 12cm/year
2-3 year: 8cm/year
3-4 year: 7cm/year
4-9 year : 5-6 cm/year
As a rule any growth rate <4.5cm/year between 2-12 year is pathological.
Short stature
This document provides an overview of short stature and approaches to evaluating a child presenting with short stature. It defines different types of short stature including familial short stature, constitutional delay of growth and puberty, endocrine causes like growth hormone deficiency and hypothyroidism, disproportionate short stature due to conditions like achondroplasia, chromosomal disorders, emotional deprivation, nutritional causes, and chronic diseases. It also discusses evaluating growth parameters, genetic potential, bone age, causes of short stature, and the role and issues with growth hormone therapy.
Pediatric obesity.,
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Approach to short stature
This document discusses the approach to evaluating and managing short stature in children. It begins with definitions of short stature and causes of growth failure. Evaluation involves assessing height, growth velocity, dysmorphic features, and family history. Common causes discussed include genetic syndromes, endocrine disorders like growth hormone deficiency, and systemic/environmental factors. Growth hormone deficiency is evaluated in depth, including types, testing, and treatment indications and management. The literature review finds growth hormone deficiency and idiopathic short stature are common in Saudi Arabia and discusses findings on treatment outcomes and safety.
approach to short stature
The document provides information on evaluating and diagnosing short stature in children. It defines short stature as height more than 2 standard deviations below the median for age and gender. It discusses evaluating growth velocity and proportions, considering causes like familial, constitutional, medical conditions affecting the GH-IGF axis, malnutrition, chronic illness, genetic syndromes, and psychosocial factors. The diagnosis involves a detailed history, physical exam including measurements, and laboratory tests to identify potential causes.
Presentation1 severe acute malnutrition
This document provides guidelines for the management of severe acute malnutrition (SAM) in children aged 6 months to 5 years. It outlines the stabilization phase (days 1-2), which focuses on preventing death while stabilizing the child by addressing hypoglycemia, hypothermia, dehydration, electrolyte imbalances, infections, and micronutrient deficiencies. It then describes the rehabilitation phase (days 3-7 and weeks 2-6), which focuses on catch-up growth through initiation of feeding, sensory stimulation, and preparation for follow-up care. The document provides detailed protocols for treatment during each stage.
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This document provides an overview of inborn errors of metabolism (IEM). It discusses that IEM have an overall incidence of 1 in 1000 to 1 in 2000 births. The most common presentation is sepsis in 30% of cases. IEM are classified based on the defective metabolic pathway, such as amino acid metabolism defects, carbohydrate metabolism defects, and organic acidemias. Clinical pointers for suspected IEM include deterioration after apparent normalcy, hypoglycemia, metabolic acidosis, abnormal urine odor, and dysmorphic features. Evaluation of neonates involves blood tests, blood gases, glucose and ammonia levels, urine analysis, and plasma amino acid analysis to identify specific disorders. Management involves identifying and limiting the offending substance
Approach to Hypoglycemia in childhood
This document discusses the approach to hypoglycemia in childhood. It begins by defining hypoglycemia and describing the importance of glucose for brain development. It then discusses the pathophysiology of hypoglycemia, focusing on how the body maintains blood glucose levels through glycogenolysis, gluconeogenesis, and lipolysis. The clinical features of hypoglycemia are presented, distinguishing between sympathetic overactivity and neuroglycopenic symptoms. Common etiologies like hyperinsulinism, metabolic disorders, and systemic illnesses are outlined. The document concludes with recommendations for investigating hypoglycemia, managing acute episodes, and treating underlying causes to prevent long-term neurological consequences.
Approach to child with short stature
A child presenting with short stature should have their height, weight, growth velocity, parental heights, dysmorphic features, pubertal development, bone age, and appropriate investigations assessed. Key factors include determining if growth is proportionate or disproportionate, calculating mid-parental height and target height for comparison, and evaluating bone age to distinguish constitutional growth delay from other causes. A thorough history, physical exam, and targeted laboratory tests can help identify underlying causes like genetic syndromes, malnutrition, endocrine disorders, or chronic illnesses.
Pediatric hypertension
This document discusses approaches to diagnosing and treating hypertension in children. It defines hypertension and outlines stages of severity. In infants and young children, hypertension is usually secondary to an underlying condition, while adolescents can develop primary or essential hypertension. Evaluation involves measuring blood pressure properly, considering causes of secondary hypertension, assessing for target organ damage like left ventricular hypertrophy, and determining if hypertension is primary or secondary. Treatment involves lifestyle changes, weight management if overweight, and potentially medications to lower blood pressure below guidelines.
growthdisorders-141014114149-conversion-gate02.pdf
Growth disorders can cause both short and tall stature. Short stature is defined as height below the 3rd percentile and may be due to familial, genetic, nutritional, endocrine, or environmental factors. Evaluation involves assessing growth velocity, bone age, and screening for underlying causes. Common causes are familial short stature, constitutional growth delay, and growth hormone deficiency. Tall stature is defined as height above the 2 SD line and may be due to genetic factors, growth hormone excess, precocious puberty, or underlying syndromes like Marfan syndrome. Evaluation involves assessing family history and screening for hormonal or metabolic abnormalities.
Growth Disorders
This document provides an overview of growth disorders including short and tall stature. It discusses the evaluation and causes of short stature such as growth hormone deficiency, Turner syndrome, and Prader-Willi syndrome. For growth hormone deficiency, it outlines the diagnostic process including stimulation tests and treatment with growth hormone. For tall stature, it reviews genetic, hormonal, and syndromic causes such as familial tall stature, precocious puberty, and Marfan syndrome.
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Basic approach on short stature in children
This document provides an overview of short stature, including definitions, types, diagnostic principles, causes, and management. It defines short stature as height below the 3rd percentile and discusses types such as familial short stature. Diagnosis involves accurate height measurements, bone age assessment, mid-parental height comparison, and medical investigations. Causes include growth hormone deficiency, Turner syndrome, and small size at birth. Management consists of dietary counseling, growth hormone injections, and limb lengthening procedures depending on the underlying cause.
Pediatric growth hormone deficiency
This document provides information on pediatric growth hormone deficiency. It discusses GH secretion and control, GH physiology, the metabolic effects of GH, and approaches to evaluating and diagnosing a child with short stature. Causes of GH deficiency include defects in the hypothalamus or pituitary gland due to genetic mutations, injuries, or tumors. GH stimulation tests are used to diagnose GH deficiency. Treatment involves recombinant human GH therapy to improve growth and development.
Short Stature.pptx
1. Short stature can be caused by familial, constitutional, or pathological factors. Familial short stature runs in families while constitutional short stature involves delayed puberty.
2. Pathological short stature can be disproportionate involving abnormal limb ratios, or proportionate involving prenatal issues like IUGR or postnatal diseases/nutritional disorders.
3. Evaluating a short child involves assessing growth charts, growth velocity, bone age, family history, and screening tests to classify the cause of short stature.
Short stature Dr.M.Sucindar
This document discusses short stature in children, defining it as height below 2 standard deviations for age and gender. It outlines factors that can affect height, including nutrition, hormones, and intrauterine growth. Short stature is classified as dysmorphic, proportionate, or disproportionate. Evaluation involves medical history, physical exam, auxiliary tests like bone age and growth hormone stimulation, and considering familial, constitutional, nutritional, endocrine, and genetic causes. Management depends on the underlying etiology and may include counseling, dietary changes, surgery, hormone replacement, or growth hormone therapy.
Short stature 2017
This document discusses the evaluation and management of short stature in a 5 year 8 month old boy brought by his parents for concerns about his growth. The boy has a history of chronic constipation since birth and poor appetite. On examination, he is below the 3rd percentile for height and has soft dysmorphism. Differential diagnoses discussed include gastrointestinal, renal, hematological, and endocrine causes. Growth hormone deficiency is evaluated in detail, including epidemiology, causes, clinical presentation, investigation involving growth hormone stimulation tests, and management with growth hormone replacement therapy. Complications of treatment and new therapies are also mentioned.
Approach to a child with short stature AG
1) Short stature can be caused by disease, disability, or social stigma and requires evaluation.
2) A child is considered short if their height is below the 3rd percentile or more than 2 standard deviations below the median height for their age and sex.
3) Approximately half of children with short stature have a physiological/familial cause, while the other half have a pathological cause like malnutrition, chronic illness, hormonal deficiencies, or genetic syndromes.
4) Evaluation of a child with short stature involves taking a thorough history, performing anthropometric measurements and growth chart analysis, conducting a physical exam, and ordering initial lab tests and bone age assessment.
Short stature
1. Short stature can be defined as a height more than 2 standard deviations below the mean height for age and gender.
2. Evaluation of a child with short stature includes assessing height, mid-parental height, bone age, basic lab tests, growth hormone stimulation tests, and IGF-1 and IGFBP-3 levels.
3. Causes of short stature include growth hormone deficiency, Turner syndrome, chronic renal insufficiency, and being small for gestational age. Growth hormone treatment dosages vary depending on the underlying cause.
Approach to hypoglycemia in infants and children
Some additional things to ask in the history:
- Family history of similar episodes or endocrine disorders
- Dietary history, including any changes in appetite/food intake
- Growth pattern and any slowing of growth
- Pubertal development
Some additional things to examine:
- Vital signs - check for signs of dehydration, shock
- Detailed physical exam looking for signs of other endocrine abnormalities
- Developmental assessment
- Nutritional status
Investigations to consider:
- Electrolytes, liver/renal function tests
- Cortisol, ACTH to check for primary adrenal insufficiency
- Thyroid function tests
- Growth hormone stimulation test
- Blood glucose curve/
Growth hormone deficiency states and growth hormone replacement therapy
Growth hormone deficiency can occur in children or adults. In children, it presents as short stature and delayed growth. In adults, non-specific symptoms include reduced energy, quality of life, and increased cardiovascular risk. Growth hormone deficiency is investigated through stimulation tests and IGF-1 levels and treated with recombinant human growth hormone via daily injections, with doses titrated based on response. Treatment aims to normalize growth in children and improve symptoms and quality of life in adults.
Hypertension in children and adolescent
Hypertension in children and adolescents is increasing in prevalence. The actual prevalence of clinical hypertension is approximately 3.5%, while the prevalence of prehypertension is 2.2-3.5%. High blood pressure in childhood increases the risk of adult hypertension and metabolic syndrome. Both primary and secondary causes of hypertension can occur in children. Treatment involves lifestyle modifications like diet and exercise changes as well as pharmacological treatment with medications like ACE inhibitors, ARBs, or calcium channel blockers if lifestyle changes are not effective. The goals of treatment are to lower blood pressure below the 90th percentile or 130/80 mmHg to reduce future cardiovascular risks.
Approach to short stature ppt.pptx
Approach to Short Stature
Dr Raheel Ahmed
FCPS in Paediatric Medicine
Children Hospital, Chanka Medical College, Larkana
Topics
Definition.
Etiology
Measurements.
Examination.
Investigations.
Management.
Take home message.
Who is short child?
Short stature is defined as height that is two standard deviations below the mean height for age and sex (less than the third percentile).
OR
more than two standard deviations below the mid-parental height.
Etiology
Proportionate Short Stature
1) Normal Variants:
i) Familial
ii) Constitutional Growth Delay
2) Prenatal Causes:
i) Intra-uterine Growth Restriction-
Placental causes, Infections, Teratogens
ii) Intra-uterine Infections
iii) Genetic Disorders (Chromosomal
& Metabolic Disorders)
Postnatal Causes:
i) Undernutrition
ii) Chronic Systemic Illness
- Cardiopulmonary: CHD, Chronic Asthma,
Cystic Fibrosis
- Renal: RTA, CRF, Steroid dependent
Nephrotic Syndrome
- GI and Hepatic: Malabsorption, IBD, chronic
liver disease
- Chronic Severe Infections
- Hematological : Thalassemia, Sickle cell
anemia
iii) Psychosocial Short Stature
(emotional deprivation)
iv) Endocrine Causes:
- Growth Hormone Deficiency/ insensitivity
- Hypothyroidism
- hypopituitrism
- Diabetes Mellitus
- Cushing Syndrome
- Pseudohypoparathyroidism
- Precocious/ delayed puberty
Disproportionate Short Stature
1) With Short Limbs:
Achondroplasia,
Hypochondroplasia,
Chondrodysplasia punctata,
Chondroectodermal Dysplasia,
Diastrophic dysplasia,
Metaphyseal Chondrodysplasia
Osteogenesis Imperfecta,
Refractory Rickets
2) With Short Trunk:
Spondyloepiphyseal dysplasia,
Mucolipidosis
Mucopolysaccharidosis
Mid Parental Height
TCR
Calculated by MPH +-10
How to measure upper and lower segments?
You should measure the upper segment( US ) then by using the total height you will obtain LS.
Upper segment is the sitting height.
Disproportionate short statue with short LS:-
Achondroplesia
Osteogenesis imperfecta.
Refractory rickets.
Disproportionate short stature with short US:-
Spondyloepiphysial dysplasia.
Mucopolysaccharidosis.
Growth velocity
0-1 year : 25cm/year
1-2 year: 12cm/year
2-3 year: 8cm/year
3-4 year: 7cm/year
4-9 year : 5-6 cm/year
As a rule any growth rate <4.5cm/year between 2-12 year is pathological.
Short stature
This document provides an overview of short stature and approaches to evaluating a child presenting with short stature. It defines different types of short stature including familial short stature, constitutional delay of growth and puberty, endocrine causes like growth hormone deficiency and hypothyroidism, disproportionate short stature due to conditions like achondroplasia, chromosomal disorders, emotional deprivation, nutritional causes, and chronic diseases. It also discusses evaluating growth parameters, genetic potential, bone age, causes of short stature, and the role and issues with growth hormone therapy.
Pediatric obesity.,
obesity in children , causes of obesity, approach to children obesity, complication of obesity, obesity definition, how to manage obesity, guidelines in pediatric obesity
Approach to short stature
This document discusses the approach to evaluating and managing short stature in children. It begins with definitions of short stature and causes of growth failure. Evaluation involves assessing height, growth velocity, dysmorphic features, and family history. Common causes discussed include genetic syndromes, endocrine disorders like growth hormone deficiency, and systemic/environmental factors. Growth hormone deficiency is evaluated in depth, including types, testing, and treatment indications and management. The literature review finds growth hormone deficiency and idiopathic short stature are common in Saudi Arabia and discusses findings on treatment outcomes and safety.
approach to short stature
The document provides information on evaluating and diagnosing short stature in children. It defines short stature as height more than 2 standard deviations below the median for age and gender. It discusses evaluating growth velocity and proportions, considering causes like familial, constitutional, medical conditions affecting the GH-IGF axis, malnutrition, chronic illness, genetic syndromes, and psychosocial factors. The diagnosis involves a detailed history, physical exam including measurements, and laboratory tests to identify potential causes.
Presentation1 severe acute malnutrition
This document provides guidelines for the management of severe acute malnutrition (SAM) in children aged 6 months to 5 years. It outlines the stabilization phase (days 1-2), which focuses on preventing death while stabilizing the child by addressing hypoglycemia, hypothermia, dehydration, electrolyte imbalances, infections, and micronutrient deficiencies. It then describes the rehabilitation phase (days 3-7 and weeks 2-6), which focuses on catch-up growth through initiation of feeding, sensory stimulation, and preparation for follow-up care. The document provides detailed protocols for treatment during each stage.
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This document provides an overview of inborn errors of metabolism (IEM). It discusses that IEM have an overall incidence of 1 in 1000 to 1 in 2000 births. The most common presentation is sepsis in 30% of cases. IEM are classified based on the defective metabolic pathway, such as amino acid metabolism defects, carbohydrate metabolism defects, and organic acidemias. Clinical pointers for suspected IEM include deterioration after apparent normalcy, hypoglycemia, metabolic acidosis, abnormal urine odor, and dysmorphic features. Evaluation of neonates involves blood tests, blood gases, glucose and ammonia levels, urine analysis, and plasma amino acid analysis to identify specific disorders. Management involves identifying and limiting the offending substance
Approach to Hypoglycemia in childhood
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Short stature a Diagnostic approach
- 1. short stature A diagnostic approach DR: MH RADI SENIOR REGISTRAR OF PEDIATRICS
- 2. INTRODUCTION Short stature is defined as a height that is 2 standard deviations (SD) or more below the mean height for individuals of the same sex and chronologic age in a given population.
- 4. NORMAL GROWTH In general, a normal pattern of growth suggests good health. Slow growth rate raises the possibility of an underlying pathological cause of growth failure. Statural growth is a continuous but not linear process. There are three phases of postnatal growth (infantile, childhood, and pubertal), each of which has a distinctive pattern [5]. The phases are similar for boys and girls, but the timing and pace of growth differ, particularly during puberty.
- 7. LINEAR GROWTH FAILURE • height significantly below genetic potentials (-2 SD below mid-parental target) • abnormally slow growth velocity • downwardly crossing percentile channels on growth chart
- 10. EVALUATION OF GROWTH ●How short is the child? ●Is the child's height velocity (HV) impaired? ●What is the child's likely adult height?
- 11. How short is the child? 1- Measure Below 2 years = Length Above 2 years = Height
- 12. Proportionate ? Upper segment : Lower segment ** (substract lower segment from total height) At birth = 1.7 At 3 years = 1.3 At Puberty = 1
- 13. Don't forget the WEIGHT !
- 14. Is the child's height velocity impaired? serial measurements of height, which should be measured along with weight at each well-child visit can be considered a "vital sign“ PATHOLOGIC VS nonpathologic HV between the 10th and 25th percentile should raise concern for possible growth failure, and an HV below the 10th percentile warrants a thorough evaluation for growth failure.
- 15. What is the child's likely adult height? 1- Midparental height Boy = (Father + Mother + 13) / 2 Girl = (Father + Mother - 13) / 2 2- Projected height +- 8.5 cm (2 SD) of the midparental height
- 16. Bone Age
- 17. BA = CA Familial ...... or .... Genetic / Endocrinal BA < CA Constitutional ...... or .... Chronic dse / Endocrinal BA > CA Obesity ...... or .... Prec. Pubery / Premature closure of epiphysis / Hyperthyroidism / CAH
- 18. ADDITIONAL EVALUATION In addition to the evaluation of growth outlined above, a focused history and physical examination contribute information that helps to categorize the cause of short stature
- 19. CAUSES
- 23. Investigations A basic evaluation : bone age determination is appropriate for children with short stature, normal growth rate and no other symptoms Broader testing: severely short (eg, height ≤-2.5 standard deviations [SD, 0.6th percentile]), has growth failure
- 24. 1- General Investigations CBC : anemia/ infection ESR : chronic infl. dse LFT : liver disfunction Urine Analysis : renal diseases
- 25. Celiac serologies (eg, tissue transglutaminase [tTG] immunoglobulin A [IgA] and total IgA) •Thyroid stimulating hormone (TSH), free thyroxine (T4) Karyotype (in all girls, to rule out Turner syndrome, and in boys with associated genital abnormalities) , insulin-like growth factor-I (IGF-I), and insulin-like growth factor binding protein 3 (IGFBP-3). •Karyotype (in all girls, to rule out Turner syndrome, and in boys with associated genital abnormalities). •Morning luteinizing hormone (LH) and follicle- stimulating hormone (FSH) in children with signs of sexual precocity
- 26. Management • treat underlying cause. • psychological support for non-treatable causes.
- 27. indications for GH treatment • GH deficiency. • Turner syndrome. • Noonan syndrome. • small for gestational age. • chronic renal insufficiency. • idiopathic short stature. • Prader–Willi syndrome
- 28. GH treatment GH dose: 0.18 - 0.3 mg/kg/day (0.5 - 1.0 units/kg/wk) at night. GH treatment should start with low doses and be titrated according to Clinical patients should be monitored at 3- month intervals
- 29. when to stop continue treatment till child reaches near final height. a height velocity of < 2cm / year over at least 9 months . bone age >13 years in girls and >14 years in boys.
- 30. complications • increased intracranial pressure. • Impaired GLUCOSE TOLERANCE TEST joint pain, muscle pain. carpal tunnel syndrome. Pancreatitis. Scoliosis. Increased risk of recurrence of neoplasim.
- 31. Gallery