Yasser is falling behind

Yasser is falling behind

1. Yasser 2 years 1 month old

   • Main diagnosis
     • Growth Hormone Deficiency
       • Growth hormone
         • Produced (somatotrophs) and secreted in
         • exerts effects on almost all tissues
           • Adipose tissue
           • Cartilage
           • Bone
           • Liver
           • Muscles
           • Indirectly
           • Directly
         • 191 amino acids-polypeptide chain-2 internal disulfide bridges
       • The pituitary gland does not make enough growth hormone
         • Criteria to Initiate Evaluation for GHD
       • Clinical presentation:
         • Congenital
           • Exaggerated jaundice in the first days
           • Growth failure
             • Slower developmental milestones
               • Reduced energy
                 • Impaired concentration
                   • Memory loss
         • Acquired
           • Delayed puberty
             • Baldness in men
               • Reduced bone mass and osteoperosis
                 • Reduced energy
                   • Increased body fats (around waist line)
       • Epidemiology
         • 3-10 in every 100 babies are born smaller than normal
       • Investications:
         • Growth chart
           • Normal
           • GHD
         • Physical examination
         • Tests:
           • Blood tests
             • GH
             • IGF-1
             • CBC
             • Serum protein
           • Karyotyping
           • X-ray
             • Left wrist
       • Treatment

2. Anatomy and histology of pituitary gland

   • Brain
     • Forebrain
       • Diencephalon
         • Ventral: hypothalamus
           • Pituitary gland
             • Hypothalamic nuclei and neuroendocrine cells
             • Adenohypophysis
               • Pars distalis
               • Pars intermedia
               • Pars tuberalis
             • Neurohypophysis
               • Pars nervosa
               • Infundibular stem
               • Median eminence

3. NORMAL growth rate

   • Height
   • Weight

4. yasser was taken to the M&CH center (maternity hospital) where they get so many services and check the child health and normal growing

   • Services:
     • All pediatric services
     • Emergency services
     • and others....

5. Follow the patient up

   • To increase compliance
   • To adjust the doses

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