Short Stature
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Transcript of Short Stature
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Short Stature:Done by
Asim .Q. Makhdom
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Def:Height less than 3 rd percentile
for age and sex
Percentile SDS3rd 1.92,5th 21st 3
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Growth velocityThe faster growth occur in UTERINE LIFE
Peak around 4th month of gestation
Slow down till birth
The 2ed acceleration takes place at PUBERTY
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Growth velocity (cont)Girls have their pack growth velocity
(9cm/y)during early puberty and before menarche
Boys have their pack (10.3cm/y)during mid puberty
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Growth velocity (cm/y)Abnormal GV Normal GV Age
<16 25.5 1st year<10 12.7 2ed year<6 6.4 2-5 years<5 5-6 5y-adloescence
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DD1.Familial 2.IUGR3.Constitutional delay in growth4.Endocrine5.Nutretional6. Syndromes7.dispropotion. 8.psycological
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Growth depend: Genetic factors: single gene disorder Vs polygenic mid parental high =target high boy(father +mother+13)/2= +_ 8,5 cm Girl(father+mother-13)/2=+-8,5 cm
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Endocrine disorders1. GH deficiency2. Hypothyroidism3. Increase cortisone4. DM5. DI6. Emotional deprivation(psychosocial
dwarfism)
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Malnutrition(35%)1. Kwashiorkor and marasmus2. Iron deficiency3. Zink deficiency4. Rickets
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Skeletal diseases1. Osteogenesis imperfecta2. Osteochondroplasia3. Achondroplasia
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Chronic diseases(20%)1. Cardiac :eg:CHD2. Plumonary:CF,asthma,TB3. Renal : RTA,CRF4. GIT : IBD5. Hepatic : liver cirrhosis6. CNS : CP
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Primordial disorders1. Turner”s syndrom2. Noonan syndrom3. Autosomal trisomy: eg: Down's syndrome
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HistoryA careful and detailed history is an important part when
assessing growth. Details of pregnancy, maternal health and birth should be addressed. In addition to inquiring about birth weight and length, the occurrence of specific prenatal, prenatal, or postnatal complications should be questioned. For example, at birth a hypoxic insult may cause hypothalamic hypopituitarism, and neonatal hypoglycaemia may imply growth hormone deficiency. Early health, past medical history and treatment, and age of recognition of short stature are important questions to ask. For example, treatment of asthma with chronic systemic or inhaled glucocorticoids can cause poor growth
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Obtaining old growth records with data on height and weight is pertinent when assessing growth.
(assessment over six months to one year) will differentiate normality from abnormality.
The height of both parents, age of onset of puberty, nutritional status, and social background are also relevant.
A family history of pubertal delay is often found in children with constitutional short stature.
Finally, genetic potential can be predicted on the basis of parental heights, and it is the midparental height which provides information necessary to determine if the child's height is appropriate for his or her family
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it is useful to define whether short stature is proportionate or disproportionate.
The sitting height plotted against total height on an appropriate chart will help in the differential diagnosis of short stature (proportionate versus disproportionate).
In addition, the ratio of upper to lower body segment is most often disproportionate in patients with primary bone disorders.
On the other hand, this ratio is normal (proportionate) in patients with chronic diseases, both endocrine and non-endocrine.
The lower segment is the distance between the top of the symphysis pubis and the floor when the patient is standing; the upper segment is calculated by subtracting the lower segment from the standing height.
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Physical examinationshould include pubertal staging and
documentation of testicular volume using a Prader orchidometer.
Both visual acuity and visual fields ought to be checked, bearing in mind the possibility of a hypothalamic pituitary lesion.
Finally, general physical examination may disclose features of recognised syndromes (for example, Turner's syndrome) or chronic disorders.
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WightHeightBone ageDisproportions
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InvestigationsBone ageTFTKarytype in girlsCBC and ESRU&EUrine analysis and
stool analysisGH test
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Summary a good history and physical examination
identify most pathological causes of short stature
Focus on looking for signs of intracranial pathology, hormones deficiency, chronic illness and GIT symptoms.
Relate the child’s height to the parents' heights.
Identify any emotional and social consequence of being short.
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