SHORT STATUREMostly short stature patients present to clinic at age of 7 years old

Any signs of puberty and at which time they commenced? As if they had early puberty: this mean they used to be tall in early life but due to early epiphyseal closure they’ll be short later on .

Medication history (long term steroid) Steroids = antigrowth hormones Dietary history

School performance : As worsened school performance may be indicative of Hypothyroidism ;

Family history: Parents’ Height Parents’ ages of Puberty

Family History of Short Stature Family History of delayed growth or Puberty

Family History of endocrinopathis or systemic illness that may affect growth

:Is the range above or below the mid-parenteral height by 8.5 cm

Target height

in any endocrine related short stature the bone age is lower than chronological age except in 3 cases :

1 .Precocious puberty : early puberty due to excess sex hormone level

2 .Congenital hyperplasia 3 .Hyperthyroidism

In these cases the bone age is higher than or equal the chronological age because these conditions cause acceleration of bone ossification early in life. In this period the child seems to get tall stature but because the epiphyseal plate become ossified earlier >> the child height stop increasing in the early age and become shorter than still up-growing child.

TRIDENT HAND DEFORMITY

-the hands are short with stubby fingers with separation between middle and ring finger

-In Achondropl.

.

IGF-1 is evaluated as a marker for growth hormone deficiency rather than GH itself because GH secretion is pulsatile

Indication of GH therapy

GH deficiency/ insufficiency Chronic renal insufficiency : for

short stature pt. Turner syndrome

IUGRIdiopathic short stature Prader- willi syndrome.

Response after GH therapy

1/3 poor responders,1/3 respond as expected

(gain 5-10 cm)1/3 excellent responders

Good Predictors: Good growth

velocity- 1st year Tall parents

Adverse effects of GH therapy

Intracranial Hypertension Oedema

Worsening of scoliosis Gynaecomatia

Slipped capital femoral epiphysis : the rapid growth of femur

causes separation of epiphysis results in severe pain and

limbing