2018 SHORT stature IPS - ipsummit.me SHORT stature IPS.pdf · Height more than 2 SD below mean for...
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Jamal Al Jubeh, MD, FAAP Consultant Pediatric Endocrinologist Chairman of Pediatrics SKMC, Abu Dhabi, UAE IPS 2018
Transcript of 2018 SHORT stature IPS - ipsummit.me SHORT stature IPS.pdf · Height more than 2 SD below mean for...
Jamal Al Jubeh, MD, FAAPConsultant Pediatric Endocrinologist
Chairman of PediatricsSKMC, Abu Dhabi, UAEIP
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Objectives� Normal and abnormal growth patterns.� Short stature and growth failure.� Causes of growth failure.� Evaluation process.
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What is normal growth?
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25 cm
12 cm
8 cm
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Growth Velocity curves
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How to measure length and height?
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Measurement of length
www.jpeds.com Vol. 164, No. 5, Suppl. 1Rogol and Hayden8/26/18 15
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Kappy et al. ■ Pediatric Practice: Endocrinology 2010: 258/26/18 16
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Rogol and Hayden www.jpeds.com Vol. 164, No. 5, Suppl. 18/26/18 17
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Measurement accuracy
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Short Stature:Definition, causes and approach
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Short Stature� Height more than 2 SD below mean for the same age
and sex compared to genetically relevant population (< 2.3 %)
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Growth evaluation� Accurate measurement of child’s height and weight.� Accurate plotting on appropriate growth chart.� Assessment of longitudinal growth (growth velocity):
Accurate heights measured at 6 - 12 month interval
� Measuring parent’s height.
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Familial (genetic) Short stature� Parents are short� Child is growing within target height range.� Child’s bone age = Chronological age
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Midparental height (Boys)
� F: Father’s height (cm)M: Mother’s height (cm)
� Midparental height in cm for boys� = (F + M + 13) / 2
� = (F + M) / 2 + 6.5
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Midparental height (Girls)� F: Father’s height (cm)
M: Mother’s height (cm)
� Midparental height in cm for Girls� = (F + M - 13) / 2
� = (F + M) / 2 - 6.5
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Familial (genetic) Short
Stature
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Constitutional Delay of Growth and Puberty (CDGP)
� Normal growth velocity.� Delayed bone age.� Delayed puberty (Often runs in the family)� Normal adult (final) height
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Constitutional Growth Delay
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Constitutional Growth Delay
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What are the causes of short stature?
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Causes of Short Stature
Genes Nutrition
Systemic Disease
SkeletalDysplasia
Syndromes
SGA
Hormones
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Systemic Diseases
GI Renal
Hem / ONC
Metabolic Cardiac
Pulmonary
•Celiac Disease•Malabsorption•IBD
•CKD•Renal Tubular Acidosis
•Thalassemia•SCD•Malignancy
•Organic Acidemia•GSD
•Cystic Fibrosis•CLD
Congenital Heart disase
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Endocrine� Hypothyroidism� Isolated growth hormone deficiency� Hypopituitarism� GH insensitivity (Laron dwarfism)� Cushing syndrome� Poorly controlled type 1 diabetes mellitus -
Mauriac syndrome � Rickets� Idiopathic short stature
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Evaluation of Short Stature
Should be based on findings from History and Physical Exam
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Evaluation of Short stature� CBC, ESR� Electrolytes & Renal Panel, Ca, Phos.� Thyroid (TSH, FT4)� Celiac Screen:
� (Tissue transglutaminase antibodies).� Chromosomal analysis (girls).� IGF-1, IGF-BP3� Bone Age X ray.
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Endocrinol Metab Clin N Am 41 (2012) 265–282
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GH – IGF1 Axis
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GH – IGF1 axis
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Endocrinol Metab Clin N Am 36 (2007) 131–186
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When to suspect Growth Hormone Deficiency (GHD)?
� Low growth velocity.� Low IGF-1, IGF-BP3� Delayed bone age.� Other causes were excluded� ± Evidence of pituitary abnormality.
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How to confirm GHD?� Growth hormone stimulation testing:� Arginine,� Clonidine.� Glucagon� Levodopa� Insulin / hypoglycemia
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If GHD is confirmed� MRI of brain (hypothalamus / pituitary)� Start GH therapy.
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Reference� Etiologies and Early Diagnosis of Short Stature and Growth Failure in Children and
Adolescents. Alan D. Rogol, MD, PhD1, and Gregory F. Hayden, MD
� (J Pediatr 2014;164:S1-S14).
� Kappy et al. ■ Pediatric Practice: Endocrinology 2010: 25
� Endocrinol Metab Clin N Am 41 (2012) 265–282
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Thank YouIP
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