Yasser's falling behind

Yasser's falling behind

1. seemed short for his age

   • weight wos found to be 11.0 kg, which wos ot the 10th centile for his age,while his height of 81 cm wos below the 3rd centile, well below the normol range for his age.
     • Dr Serag then performed o physical exomination. Yosser's present height ond weight were measured, plotted ond compored with previous doto from visits
       • Dr Serag said thot some tests were needed now to determine the cause of Yasser's slow growth rate
         • overnight hospitol stoy for seperate tests to determine if Yosser wos producing growth hormone
           • X-roys were ordered
             • diagnosed with growth hormone deficiency
               • Dr Serog reossures them thot GH treatment will probobly result in ropid, 'cotch-up' growth for a period followed by o period of noimol growth so thot Yosser should ottoin his genetic qdult height potential
                 • Recombinant hGH Daily, 25-50 μg/kg/day 3-6 months
                   • Technology that allows a DNA fragment from any source to be joined in vitro with a nucleic acid vector that can replicate autonomously in microorganisms.
                     • Restriction endonuclease Insert into a vector Any piece of DNA (plasmid, viral, yeast, chromosome) Restriction endonuclease+ligase Transform host cells The colonies produced
                   • primary objectives of the therapy of GHD are normalization of height during childhood and attainment of normal adult height
                 • patients who are receiving growth hormone therapy 2-4 times per year. The most important reasons for follow-up are to monitor growth progress and to adjust growth hormone dosage.
               • causes
                 • A severe head injury
                 • A tumor in your head
                 • history of pituitary tumors
                 • Radiation treatments to your brain
                 • Hormonal problems related to the hypothalamus gland or pituitary gland
             • bone age test
           • Secretion: Somatotrophs cells of anterior pituitary (30 -40% of cells)
             • Control of secretion: •GH releasing hormone. •GH inhibiting hormone (Somatostatin).
               • Normal concentration of growth hormone in plasma is 1.6 to 3.0 ng/ml for adults and 6 ng/ml for children or adolescents
                 • Growth hormone is secreted in a pulsatile pattern
           • factors affecting production
             • blood glucose levels
             • aging
             • obesity
             • blood free fatty acids
             • somatomedins
             • trauma
             • exercise
             • deep sleep
         • TFTs IGF1 and IGF BP3
           • Random GH
             • Brain CT/skull x-ray
       • Symptoms of GH deficiency
         • Child's face may appear younger than children who are the same age
           • Delayed puberty—but sometimes a child won't go through puberty
             • Increased fat around the face and stomach
               • Sluggish hair growth
       • history taking
         • Height of parents
           • Calculation of the sex-adjusted midparental height, also termed the "target height," helps evaluate a child's genetic potential.
         • • Timing of puberty in parents
           • Constitutional delay in growth and maturation may have a family history. Most mothers can remember their age at menarche
         • General health of child: Exclusion of chronic disease as the cause of short stature is imperative.
         • • Nutritional history: malnutrition is the most common cause of short stature worldwide.
       • • Previous growth points
         • check child's growth pattern
       • Height and weight measurement
         • Proportionality
           • Pubertal status
     • growth charts
   • Reduce mortality and morbidity among mothers, infants and pre- school children
     • Prevent communicable diseases
       • Early diagnosis and treatment of the health problems
   • differentials for delayed growth

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