Professional Documents
Culture Documents
PEDIATRIC ENDOCRINE
DISEASE
DEFINITION
The term short stature describes height
that is in the third percentile as compared
to the average height for a persons age,
sex, and racial group
Causes
Normal variants
Non-endocrine causes
Endocrine causes
Chronic disease
- Cardiac disorder
Left to right shunt
Congestive heart failure
- Pulmonary disorders
Cystic fibrosis
Asthma
- Gastrointestinal disorders
Malabsorption (eg, celiac disease)
Disorders of swallowing
- Hepatic disorders
- Hematologic disorders
Sickle cell anemia
Thalassemia
- Renal disorders
Renal tubular acidosis
Chronic uremia
- Immunologic disorders
Connective tissue disease
Juvenile rheumatoid arthritis
Chronic infection
Endocrine disorders
GH deficiency and variants
- Congenital GH deficiency
- With midline defects
- With other pituitary hormone deficiencies
- Isolated GH deficiency
- Pituitary agenesis
- Acquired GH deficiency
Hypothalamic-pituitary tumors
Histiocytosis X
Central nervous system infections
Head injuries
GH deficiency following cranial irradiation
Central nervous system vascular accidents
Hydrocephalus
Empty sella syndrome
- Abnormalities of GH action
GH insensitivity (Larons dwarfism)
Primary IGF-1 deficiency
IGF receptor defect
Psychosocial dwarfism
Hypothyroidism
Glucocorticoid excess (Cushings syndrome)
Endogenous
Exogenous
Pseudohypoparathyroidism
Disorders of vitamin D metabolism
Diabetes mellitus, poorly treated
Diabetes Insipidus, poorly treated
Normal variants
Familial (genetic) short stature and
constitutional short stature are common
variations of normal.
Individuals with familial short stature have a
normal growth rate even though it is below the
5th percentile
They do not have skeletal delay, puberty and
pubertal growth spurt occur at the usual
chronological age, and final height is
appropriate for mid-parental target height
Normal variants
Those with constitutional short stature have growth
deceleration in the first two years of life, with normal
growth velocity being achieved by age three and
continuing throughout childhood
Onset of puberty is usually delayed
Adult height is in the normal range but varies according
to parental height
Non-endocrine causes
Endocrine causes
Growth hormone deficiency or insufficiency is an uncommon
cause of short stature
Prevalence of the condition :1 in 4000
Classic GH deficiency : short stature, increased fat mass leading
to a chubby appearance with immature facial, immature highpitched voice, and delay in skeletal maturation.
The calvarium seems to be relatively overgrown (delayed closure
of fontanelles), with prominence of the frontal bone
Endocrine causes
The impairment of growth in Cushing's
syndrome is predominantly the result of a
direct effect at the growth plate. The
commonest cause is iatrogenic
(treatment with glucocorticoids), with
endogenous glucocorticoid excess
(Cushing's syndrome dependent on the
pituitary and adrenal glands) being much
rarer.
Causes
Several factors contribute to short stature, including:
Genetic factors (eg, skeletal dysplasias, Turner syndrome , Downs syndrome ,
Silver Russell syndrome)
Endocrine disorders (eg, hypothyroidism , growth hormone deficiency)
Delayed puberty (causes temporary short stature, but normal height is eventually
achieved)
Early puberty
Malnourishment (on a global scale, this is the most common cause of growth
failure and is generally associated with poverty)
Chronic diseases:
HISTORY TAKING
1. Initiating the session
- Greeting, Introduce, obtain patients name, sex, date of birth, and
Address
3. Gathering information
- History of present illness
- Birth History
- Family History
- Medications
- Accidents
4. Closing
- Pregnancy
- History of Development
- History of Disease
- Diet
- Social
History of present
illness
The onset
Other symptom(s)
Pregnancy
Nutritional status
Toxic or medication exposure
Gestational age
Birth History
Delivery
APGAR score
Birth weight & length
History of Development
Age of milestone : sitting, walking, speaking
words
Educational achievement
Family History
History of Disease
Gastrointestinal
Lung
Heart
Kidney disease
Anemia
Medications
Corticosteroids
DIET
Adequate food (quantity)
Quality (healthful)
Accidents
Head
SOCIAL
Home : interaction
School : interrelationship with schoolmates