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Updated: Jan 1 2022

Growth Disorders

  • 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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