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Growth and its disorders

Growth and its disorders. Mohsen Atawi Consultant pediatric endocrinology & Diabetes King Abdullah specialized children hospital. What is the impact of short staure ?. Reproductive issue- partner selection Academic achievement Job chances Work-related issues Clothing / media

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Growth and its disorders

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  1. Growth and its disorders Mohsen Atawi Consultant pediatric endocrinology & Diabetes King Abdullah specialized children hospital

  2. What is the impact of short staure ? • Reproductive issue- partner selection • Academic achievement • Job chances • Work-related issues • Clothing / media • Political issues

  3. Mechanisms of Linear Growth What initiate chondrocytes proliferation Role of GH-Initial phase Role of IGF-Later What is the role ofmaturatedchondrocytes Matrix secreation Mineral phase Why apoptosisnot death of mature chondrocytes

  4. Phases of linear growth 20 cm/y 5 cm/y 25 cm/y Adolescent 70 cm/y childhood Infancy Fetus C B 2 y 10 y 18 y

  5. Essential facts • The highest GV in human is during thefetal life • SeveralMaternal-Fetal-Enviromental may limit /impair fetus growth • No compensationbetween growth phases , however some catch-up • Early recognition of linear growth failure and prompt correction is critical for optimal Final adulthood

  6. When to consider short stature? • The definition of Short stature is when height is < 2 SD Below mean for age-sex ( i.e below 3rd centile ) limitations of this definition are : > is pure “statistical” definition > is “population” based ( variable) > By this definition, 2.5% of the population are short The Utah Growth Study is the largest population-based survey of growth in children (1994). The study assessed height and growth velocity in nearly 100,000 American children there where 550 children with short stature (defined as height below the 3rd percentile)

  7. Growth assessment • By using Growth charts for age and gender • The growth charts should be population based (e.g Saudi growth charts) • Availability of growth charts (Males /females) • Birth-36 months • 2 years-20 years

  8. How to use the Growth charts • proper measurement • < 2 year : infantometer • > 2 year : Stadiometer

  9. Birth to 36 months

  10. 2 years to 20 years

  11. Growth and its disorders • Definition of short stature • If the length (infant) or height (children) more than 2 SD below the mean for age and sex

  12. Step-wise approach to a child with SS 1-Is this child short ? • Use 3-97 percentile chart • Obtain the child accurate height 2-Determine the Onset In utero or post birth ? Pre-natal-is the child born IUGR ,syndromatic genetic disorders , maternal /toxins Post-natal – asphyxia , CNS insult , feeding problems , chronic diseases

  13. 3-Is the shortness proportionate / disproportionate ? • Measure the US & LS • Take in account the normal ratio for each Age group US/LS RATIO US>LS OR LS>US US=LS disproportionate proportionate SHORT TRUNK SHORT LIMBS

  14. Proprtionate SS US=LS Weight Obese Normal Thin R/o Endocrine disorders Systemic disease Hematological Gastroenintestinal Renal Genetic disorders Endocrine Syndromes FSS CSS FH : +VE +VE GV : Normal Normal BA : =CA <CA

  15. Growth Hormone def (Autosomal recessive)

  16. Growth Hormone Resistance (Autosomal recessive)

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