Growth and Development Disorders GHD Diagnosis Treatment

DISORDERS OF GROWTH AND DEVELOPMENT

Growth is dependent on GH, IGF, sex steroids, thy­roid hormones, paracrine growth factors and cytokines.

Growth also requires caloric energy, amino acids, vi­tamins and trace metals.

Short stature results due to intrinsic and extrinsic factors which impair growth.

Growth  GHD CausesGram-Positive Streptococci Bacterial Infections Causes Diagnosis Treatment. Read more ... » may be :

• Most common cause of GHD in children is idiopathic.
• Most common cause of GHD in adults is a pituitaryAldosteronism Clinical features Causes and Treatment. Read more ... » adenoma or treatmentGram-Positive Streptococci Bacterial Infections Causes Diagnosis Treatment. Read more ... » of the adenoma with surgery or radiotherapy:
• · Hormonal disorders
• · Systemic disorders
• · Genetic disorders
• · Hereditary disorders

• GH deficiency causes short stature, increased fat, high pitched voice, hypoglycemia, micropenis.

 Growth Classic Stage Theories

	INFANCY (0–1 YR)	TODDLERHOOD (2–3 YR)	PRESCHOOL (3–6 YR)	SCHOOL AGE (6–12 YR)	ADOLESCENCE (12–20 YR)
Freud: psychosexual	Oral	Anal	Phallic/oedipal	Latency	Genital
Erikson:psychosocial	Basic trust vs mistrust	Autonomy vs shameand doubt	Initiative vs guilt	Industry vs inferiority	Identity vs role diffusion
Piaget:cognitive	Sensorimotor	Sensorimotor	Preoperational	Concrete operations	Formal operations
Kohlberg:moral	—	Preconventional:avoid punishment/obtain rewards (stages 1 and 2)	Conventional:conformity (stage 3)	Conventional:law and order (stage 4)	Postconventional:moral principles

Growth  GHD CLINICAL PRESENTATION —

• GHD can be divided into congenital and acquired forms.
• A variety of congenital genetic causes of GHD:
• GH secretagogue receptor gene defects
• GH gene defects
• Transcription factor defects (PIT-1, PROP-1, LHX3/4, HESX-1, and PITX-2)
• GHRH receptor gene defects
• GH receptor/postreceptor defects
• Prader-Willi syndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... »
• The single most important clinicalGram-Positive Streptococci Bacterial Infections Causes Diagnosis Treatment. Read more ... » manifestation of GHD of all causes is growth failure, and careful documentation of growth rate is critical to making the correct diagnosisGram-Positive Streptococci Bacterial Infections Causes Diagnosis Treatment. Read more ... ».

Physical Exam Growth  GHD 

• •Children with GHD:

  • Most common presentation is short stature
  • Assess pubertal status using Tanner staging systemGram-Positive Streptococci Bacterial Infections Causes Diagnosis Treatment. Read more ... ».
  • Severe GHD children have maxillary hypoplasia and forehead prominence; kewpie doll appearance.
  • Accurately measure height and weight.
  • Newborns may present with hypoglycemia, jaundiceCauses of jaundice with diagnosis and bio markers. Read more ... », or micropenis.

• •Adults:

  • Decreased lean body mass
  • Poor bone density

Associated Conditions

• Macroadenoma
• SarcoidosisSarcoidosis Causes Diagnosis Symptoms and Treatment. Read more ... »
• Sheehan syndrome

Treatment

• is replacement with GH 0.05 mg/kg/day subcutaneously for growth of 10 cm/year.

Growth  GHD Adult GH deficiency

• is caused by hypothalamicHypothalamic, Pituitary And Other Sellar Masses. Read more ... » or pituitary damage of area secreting GH. Later there may be FSH / ~H, TSHACTH and TSH DEFICIENCY Diagnosis with Treatment. Read more ... » and ACTHACTH and TSH DEFICIENCY Diagnosis with Treatment. Read more ... » deficiency also.
• There is lean body with fat abdomen, and increased waist size, hyperlipidemia, hypertensionThyrotoxic crisis or Thyroid storm. Read more ... »,’ left ventricu­lar dysfunction.

Growth  GHD Treatment ,

• Replacement of GH 1.25 mg/day. Women require higher levels then men.
• Liquid solutions for SC injection: These are available in multidose pen devices.
• Encapsulated GH in glycolide microspheres for deep SC administration.
• Either 1.5 mg/kg body weight once a month or 0.75 mg/kg twice a month.
• Daily therapy is more effective than 3-times-a-week therapy. The recommended dose is 0.04 mg/kg/d for children

Acromegaly

• This is due to increased secretion of growth hormoneAnterior Pituitary Hormones and Disorders. Read more ... » due to pituitary adenoma, extrapituitary tumors, hy­pothalamic tumors, pancreatic islet cell tumorArbuda or Cancer Ayurvedic Review. Read more ... », adre­nal and thyroidThyrotoxic crisis or Thyroid storm. Read more ... » tumors, pheochromocytomaDIAGNOSIS and Investigations OF SECONDARY HYPERTENSION. Read more ... ».
• It is diagnosed at the age of 10 years or more. There is frontal bossing (prominent forehead), in­creased hand and foot size, wide thick jaw, space be­tween incisor teeth, thick heal pads, coarse facial fea­tures, large nose, muscle weakness, oily skin, cardi­omegaly, thick tongue etc. Patient looks abnormally huge.
• There is premature coronary heartCardiac Arrhythmias Definitions Mechanisms and Methods for Detecting Arrhythmias. Read more ... » diseaseGram-Positive Streptococci Bacterial Infections Causes Diagnosis Treatment. Read more ... », cardiomy­opathy, arrhythmiasCOMPLICATIONS OF Acute Myocardial Infarction (AMI) AND TREATMENT -2. Read more ... » and death. These patients have obstructive sleep apneaSleep Disorders Types Diagnose Of Sleep Disorders. Read more ... », diabetes mellitusOphthalmologic Complications of DM (Diabetes Mellitus). Read more ... », colonic malignancy.

Differential Diagnosis

• Down syndrome
• Idiopathic short stature
• Noonan syndrome
• Prader-Willi syndrome
• RenalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » failure
• Russell- Silver syndrome
• Small size for gestational age in newborns
• Turner syndrome

Lab diagnosis:

• IGF-I (insulinHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... »-like growth factor) level is elevated.
• There is failure of GH suppression in response to glu­cose load (75 g glucoseGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... »).
• Thyroid-stimulating hormone (TSH) (hypothyroidismThyroid Disorders Examination and Laboratory tests. Read more ... » should be excluded as a cause)
• Serum electrolytes (low bicarbonate levels may indicate renal tubular acidosisTubular Diseases of the Kidney Types Clinical Features Diagnosis with Treatment. Read more ... »)
• IGF-1, IGFBP-3
• Multiple GH levels

Treatment

• Surgical resection (transsphenoidal) Somatostatin analogues-Octreotide acetate
• Bromocriptine, a dopamine agonist may suppress GH
• Irradiation
• Stereotactic ablation by gamma knife.