02 kuliah semester vi_2011_1

7/29/2019 02 Kuliah Semester VI_2011_1

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Disorders of growth and puberty

Muhammad Faizi, AY Heryana, Netty EP


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Introduction

Growth is the fundamental physiologic process thatcharacterizes childhood.

Determined by genetic, psychosocial and economicfactors.

It should be closely monitored by health providersand families alike as a benchmark of a childs health.

Growth assessment requires an understanding of thephysiology of growth.


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Physiology of growth

Prenatal growth regulation Genetic, uterine size, placenta, metabolic status, nutrition.

Hormonal: insulin, IGFs.

Postnatal growth regulation Adequate NUTRITION.

Caring ENVIRONMENT.

Normal CHROMOSOMES.

Good HEALTH.


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Physiology of growth

4 human growth phases:

Fetal.

Infantile.

Childhood.

Pubertal.


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Fetal growth:

Peaks: 10 cm/month end of 2nd trimester.

Maximum weight gain 3rd trimester.

Nutrient supply via the placenta is the maingrowth rate-limiting step.

Placenta producing growth factors such asgrowth hormone variant, human placentallactogen and organ-specific hormones such asCRH, hepatic and epidermal growth factors.


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Fetal growth:

The fetal pancreas releases insulin inresponse to nutrient supply and this has

direct growth-promoting effects.

Fetus IGFs of which IGF-2 predominatesand modulates the growth factor actions

with specific binding proteins.

Thyroid and growth hormone dont play a


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Fetal growth:

Placental failure or damage results in agrowth-restricted infant. Including:abnormal implantation, vascularinsufficiency, or infarction.

Symmetrical.

Asymmetrical.


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Infantile growth:

Extension of the fetal growth phase beforegrowth becomes hormone dependent.

Early growth in height and weight requiresadequate nutrition but also normal thyroidfunction and bone metabolism.

HPA axis becomes increasingly active andinfants with growth hormone deficiency areshorter than may be expected even duringthe first year.


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Infantile growth:

The first 2 year: catch-up or catch-down.

Catch-up growth starts soon after birth and is

completed over 618 months.

Catch-down growth commences between 3and 6 months and is completed by 920

months.


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Genetically pote

height

CanalizationCatch-up

cm


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Genetically pote

height

CanalizationCatch-down

cm

Childh d h


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Childhood growth:

Requires growth hormone (GH)action on epiphyseal cartilage cells

to produce IGF-1, the majorpostnatal growth factor that

stimulates cell division and growth.

Childh d h


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Childhood growth:

By 4 years of age, average growth velocityhas declined to 7 cm/year and remains

relatively steady until adolescence, the

prepubertal nadir in average velocity being

5 to 5.5 cm/year.

During childhood, GH, in addition to thyroidhormone, is the major determinant of

growth.


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T f hildh d th


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Type of childhood growth:

T f hildh d th


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Type of childhood growth:

P b t l th


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Pubertal growth

Puberty may be defined as the transitionfrom the prepubertal state through the

development of secondary sexual

characteristics to the achievement of adult

stature.

b t l i iti ti


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ubertal initiation

actors:

Genetic. Nutrition. Neurotransmitter. Hormonal.


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Gonadotropin Patern

Juvenile pause


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Secondary sex Development from Tanner

F


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E l ti f th


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Evaluation of growth

Anthropometry: reliability & reproducibility.

Training.

Equipment.

Plotting.

Absolute height / Plotting. 2SD - -3SD : 80% normal variant.

< -3SD : 80% pathologic.


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evaluation


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evaluation . . .

Height velocity

Measurement at 6 mos interval.

Deceleration / crossing percentiles onage > 2 y - puberty: indicates

pathologic until proven otherwise.

Normal velocity indicates normalgrowth.

evaluation


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Weight vs height relationship.

o W/H ratio orBMI: suggestiveendocrine causes.

o W/H ratio orBMI: suggestivesystemic disease.

evaluation . . .

valuation


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dy proportion.Measurement

Sitting height and standing height.

Arm span.

Head circumference.

Upper/lower segment ratio

Birth = 1.7 and end of puberty = 1.

valuation . . .


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Adult size prediction Target height ( MPH )

Boy = Fh+Mh+13

2

Girl= Fh-13+Mh2

Predicted Final Height

MPH + 8.5 cm

t


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. . . parameterne Age

Greulich & Pyle

Comparison of left wrist.

Prediction of FH after 6 years.

Table Bayley & Pinneau.

Tanner Whitehouse II

Maturation of ossification center.

More reliable : scoring system.

Complicated.


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ormal height velocity:

Familial short stature

Constitutional delay in growth and development

oor height velocity:

Usually pathological

Proportionate

Disproportionate

Normal growth velocity


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Normal growth velocity

Poor growth velocity


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Poor growth velocity

Diagnostic Approach to Short Statur


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Diagnostic Approach to Short Statur

Bone

Dysplasi

FSS

Short Stature

Abnormal

GV

Normal GV

Constitutional Delay

Proportional Dysproporti

W/H W/H

Endocrine

Thank you


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Thank you

02 kuliah semester vi_2011_1

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