Updated: 1/1/2022

Growth Disorders

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Questions
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Evidence
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Topic
  • Overview
    • Constitutional growth delay
      • Introduction
        • the most common cause of short stature and pubertal delay
        • adolescents will have a normal growth spurt and normal adult height
      • Presentation
        • normal birth weight and height
        • drop in percentiles on growth curve between 6 months and 3 years,
        • re-establishment of normal growth velocity and following the growth curve at the 5th to 10th percentiles
      • Evaluation
        • characterized by a bone age that is less than chronological age
          • the child's short height is often appropriate when assessed in the context of their skeletal age.
        • TSH
          • best next step in management when a child falls off their growth curve
      • Treatment
        • reassurance and regular follow-up
    • Precocious puberty
      • going through puberty at a younger age than is expected
        • < 8 for girls, < 9 for boys
      • if advanced bone age:
        • Central: high FSH and LH
          • may be caused by CNS tumors
            • order head CT/MRI to rule out secondary causes
        • Peripheral: low FSH and LH
          • abnormal secretion of sex hormones from ovaries/testes/adrenal glands
      • if normal bone age:
        • isolated premature thelarche
        • isolated premature adrenarche
      • can occur secondary to obesity
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(M3.PD.16.10) A concerned mother presents to clinic stating that her 14-year-old son has not gone through his growth spurt. She states that, although shorter, he had been growing at the same rate as his peers until the past year, when he continued to grow at the same rate as he did previously, but his peers started to grow more rapidly in height. There is no evidence of delayed puberty in the mother, but the father's history is unknown. The patient has no complaints. On physical exam, the patient is a healthy-appearing 14-year-old boy whose height is below the third percentile and whose weight is at the 50th percentile. His bone age is determined to be 11 years. A laboratory workup, including thyroid stimulating hormone (TSH), is unremarkable. What is the most likely diagnosis?

QID: 102764
1

Constitutional growth delay

70%

(7/10)

2

Familial short stature

10%

(1/10)

3

Hypothyroidism

0%

(0/10)

4

Celiac disease

0%

(0/10)

5

Growth hormone deficiency

20%

(2/10)

M 10 E

Select Answer to see Preferred Response

(M2.PD.15.49) A 5-year-old girl with no significant medical history is brought to her pediatrician because her mother is concerned about her axillary hair development. She first noticed the hair growth a day prior as she was assisting her daughter in getting dressed. The girl has no physical complaints, and her mother has not noticed a change in her behavior. On physical exam, the girl has scant bilateral axillary hair, no breast development, and no pubic hair. The exam is otherwise unremarkable. Activation of which of the following is responsible for this girl's presentation?

QID: 106334
1

Hypothalamus

4%

(1/23)

2

Pituitary

22%

(5/23)

3

Adrenal glands

57%

(13/23)

4

Neoplasm

9%

(2/23)

5

Ovaries

4%

(1/23)

M 5 E

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