Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Constitutional growth delay
70%
7/10
Familial short stature
10%
1/10
Hypothyroidism
0%
0/10
Celiac disease
Growth hormone deficiency
20%
2/10
Select Answer to see Preferred Response
This patient has constitutional growth delay. Appropriate management would include close follow-up for changes in growth velocity or onset of pathology; no interventions are indicated at this time. Constitutional growth delay is a diagnosis of exclusion. Patients will typically present with short stature (<3rd %tile or > 2 standard deviations (SDs) below mean height for age), no signs of systemic illness, and delayed bone age. Either one or both parents will also have a history of late-onset puberty. Importantly, patients will have demonstrated normal growth (at least 2 inches per year) over their lifespan. Barstow et al. discuss the evaluation of patients with short stature. Initial evaluation starts with a thorough history and physical. The patient should have growth velocity and midparental height calculated. Midparental height (MPH) is determined as follows: Male MPH= [Dad's height (in) + (Mom + 5 in)]/2; Female MPH= [(Dad - 5 in) + Mom]/2. Bone age should be determined by comparing a radiograph of the left wrist to those in a standardized database. Medications should be reviewed, paying particular attention to steroid use, ADHD drugs and anticonvulsants. If an endocrine or gastrointestinal disorder is suspected, the patient should have the requisite blood work drawn (complete metabolic panel, IGF-1, TSH etc.). Rogol et al. review the differential diagnosis of short stature in children and adolescents. Patients are considered to have normal variant short stature (familial short stature or constitutional short stature) when growth velocity per year is normal. Patients with pathological variants do not have normal growth velocity. Causes can be prenatal (genetic, environmental, viral) or postnatal (malnutrition, social neglect, gastrointestinal, endocrine etc.). If a patients height is >3 SD below mean for age, then there is almost always an underlying pathology causing short stature. Incorrect Answers: Answer 2: This answer choice is unlikely, as the patients bone age is less than chronological age. Answer 3: This answer is incorrect because the patient has a normal TSH and no other signs or symptoms of hypothyroidism Answer 4: Celiac disease is unlikely in this scenario, as the patient does not have any gastrointestinal symptoms, signs of malnourishment, or any other laboratory abnormalities. Answer 5: Growth hormone deficiency is unlikely because this patient has been growing at a normal growth velocity every year.
3.3
(4)
Please Login to add comment