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![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.](https://image.slidesharecdn.com/shortstatureug210812-200113193602/85/Short-stature-a-Diagnostic-approach-4-320.jpg)
![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](https://image.slidesharecdn.com/shortstatureug210812-200113193602/85/Short-stature-a-Diagnostic-approach-23-320.jpg)
![ 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](https://image.slidesharecdn.com/shortstatureug210812-200113193602/85/Short-stature-a-Diagnostic-approach-25-320.jpg)
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Short stature a Diagnostic approach
- 1. short stature A diagnosticapproach DR: MH RADI SENIOR REGISTRAR OF PEDIATRICS
- 2. INTRODUCTION Short statureis 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 Ingeneral, 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.
- 5.
- 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 isthe 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 theWEIGHT !
- 14. Is the child'sheight 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 thechild'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.
- 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 Inaddition 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.
- 23. Investigations A basicevaluation : 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- GeneralInvestigations 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 • treatunderlying cause. • psychological support for non-treatable causes.
- 27. indications for GHtreatment • GH deficiency. • Turner syndrome. • Noonan syndrome. • small for gestational age. • chronic renal insufficiency. • idiopathic short stature. • Prader–Willi syndrome
- 28. GH treatment GHdose: 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 • increasedintracranial pressure. • Impaired GLUCOSE TOLERANCE TEST joint pain, muscle pain. carpal tunnel syndrome. Pancreatitis. Scoliosis. Increased risk of recurrence of neoplasim.
- 31.
- 32.