Yasser is falling behind

Yasser is falling behind

1. Short Stature

   • Causes
     • Bone or skeletal disorders
       • Rickets
       • Achondroplasia
     • Chronic diseases
       • Asthma
       • Celiac disease
       • Congenital heart disease
       • Cushing disease
       • Diabetes
       • Hypothyroidism
     • Genetic conditions
       • Down syndrome
       • Noonan syndrome
       • Russell-Silver syndrome
       • Turner syndrome
       • Williams syndrome
     • Other reasons
       • Growth hormone deficiency
         • Pathophysiology
         • Causes
           • Deficiency of anterior pituitary secretion (panhypopituitarism)
           • Failure of somatomedin receptor or GHR response.
           • Lack of somatomedin C secretion by liver
           • Hypothalamic dysfunction (decreased GHRH)
           • Secretion of inactive growth hormone.
         • Effects
           • Physical parts of the body develop in a reduced rate, but in appropriate proportion
           • With panhypopituitary dwarfism --> no puberty or adult sexual functions
         • Diagnosis
           • History taking
             • GHD Criteria
               • Clinical presentation
                 • Delayed growth
                 • Increased fat
                 • Short stature
                 • High pitched voice
                 • Micropenis
             • Milestones of development
           • Physical Examination
             • Growth Chart
             • Height & Weight measurements
             • Calculating the expected height
               • 1. Add the mother's height and the father's height in either inches or centimeters.
               • 2. Add 5 inches (13 centimeters) for boys or subtract 5 inches (13 centimeters) for girls.
               • 3. Divide by two
             • Expectations
               • Turner syndrome
               • Down syndrome
               • Achondroplasia (dwarfism)
               • Rickets
               • Signs of hypopituitarism
           • Investigations
             • Blood Tests for Growth Hormone Deficiency
               • Binding protein levels (IGF-I and IGFBP-3).
               • Growth hormone stimulation test
                 • GHRH-arginine test
                 • Insulin tolerance test (ITT)
             • Other Exams and Tests
               • DXA scan
               • MRI of the brain
               • X-ray of the hand
               • X-ray of the head
         • Management plan
           • Pharmacological Therapy
             • Recombinant GH
               • Administered IM or SC
               • Adverse Effects
                 • Injection-site pain or arthralgias
                 • Idiopathic intracranial hypertension
                 • Hyperglycemia may develop
                 • GH may promote the growth of various types of neoplasms and increase tumor recurrence rates.
             • Recombinant Insulin-Like Growth Factor-1
               • Patients should be monitored very closely for hypoglycemia
             • Growth Hormone-Releasing Hormone
               • Sermorelin is administered daily by subcutaneous injection
         • Prognosis:
           • Child will grow 1 to 2 inches within the first 6 months of starting treatment
       • Intrauterine infections
   • Risk Factors
     • Large familiar group
     • Underweight during pregnancy
     • Malnutrition

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