Beruflich Dokumente
Kultur Dokumente
Growth
Normal growth
GH
Infant Childhood
Sex steroid
Puberty
INFANT PERIOD
Catch-down
Growth Chart
Canalization
Catch-up
cm
tahun 3
Evaluation of growth
Anthropometry
Standing & sitting : proportional Arm span GP, TW, RUT Normal, delayed, advanced prediction of final height
Bone age :
Growth chart
Growth curve
Plotting growth
Grow th Chart
195 190 185 180 175 170 165 160 155 150 145
97
50 3
Height (cm)
Age (years)
Grow th Chart
195 190 185 180 175 170 165 160 155 150 145
97
50
Height (cm)
HA
CA
Age (years)
Bone age
Comparison of left wrist(pergelangan tangan) Prediction of FH after 6 years Table Bayley & Pinneau Maturation of ossification center More reliable : scoring system complicated
Tanner Whitehouse II
Usia tulang
Short stature
Pattern(pola) of growth more important rather than absolute position on growth curve
Short stature
Delayed puberty in the family Normal growth velocity normal adult height
Prenatal onset
Nutritional Deprivation syndrome Cardiac defect Respiratory insufficiency Renal disfunction Hormonal Chronic infection, chronic disease
Etiology
Skeletal dysplasias Chromosomal abnormalities Metabolic causes IUGR (retardasi intrauterine) Syndromes Genetic
Etiology
Undernutrition Disorder of the bowel, kidney, heart, lung Psychosocial deprivation Chronic infection, drugs Endocrine disorder Idiopathic growth delay
Abnormal
Normal Variant Constitutional Delay Proportional Intrauterine Dysproportional
Extrauterine
Endocrinological causes
Normal variant : CDGP GH Deficiency Hypothyroid Precocious (prekok) Puberty Cushings syndrome Pseudohypoparathyroidism
Treatment
Hormonal
Mechanical
GH deficiency
Short stature Chubby Abdominal adiposity Micropenis Single central incisor Frontal bossing Proportional
GH Deficiency
Low growth velocity : < 25% Retarded bone age GH level < 10 ng/dl
Low IGF-1
Causes of GH Deficiency
Congenital
Idiopathic Genetic Assosiated anatomic defect : SOD,midline defect Trauma Neoplasma Cranial irradiation etc
Acquired
Treatment
Terminate :
CDGP
Family history Growth velocity normal Bone age retarded Puberty : late Adult height : normal Treatment : No Need
Congenital hypothyroidism
Large posterior fontanelle Respiratory difficulty Hypothermia Feeding difficulty Lethargy Delay in passing meconium Abdominal distention Vomitting Prolonged jaundiced Oedema
Cushings Syndrome
Hypertension Obesity predominant : trunk and neck, moon face Disturbances of glucose metabolism Purple striae, hirsutism, osteoporosis, hypogonadism Muscular weakness
Pseudohypoparathyroidism
Short stature Mental retardation Albrights osteodystrophy Round facies Ectopic calcification
Pola pertumbuhan
Conclusion
Short stature
Clue to diagnosis
Etiology
Tall Stature
Etiology
Genetic
Hormonal
Syndromes
Metabolic disorders
Diagnostic approaches
Treatment
Psychosocial problem Female > male Ethynil estradiol 100 ug/day Testosterone 200 - 250 mg every 2 3 week
Conclusion
Clue to diagnosis