gds137 slide pemeriksaan laboratorium dan interprestasi pada growth retardation tiroid2
TRANSCRIPT
![Page 1: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/1.jpg)
PEMERIKSAAN LABORATORIUMDAN INTERPRETASIDAN INTERPRETASI
PADA GROWTH RETARDATION
Prof. dr. Burhanuddin Nst. SpPK (K)
1
![Page 2: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/2.jpg)
Pendahuluan
Masa anak-anak adalah waktu untuk tumbuh, k k l k d lib tkmerupakan proses komplek dan melibatkan
interaksi banyak faktor.P t b h d l h bi t k iPertumbuhan adalah biasa untuk organisme multicellular dan terjadi dengan cara pembelahan sel dan pembesaran sel danpembelahan sel dan pembesaran sel dan organ differensiasi
2
![Page 3: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/3.jpg)
Perkembangan morfologi secara menyeluruh d k t b l h l ddan kecepatan pembelahan sel pada berbagai organ pada waktu yang berbeda dan outcome yang diperoleh ditentukan olehdan outcome yang diperoleh ditentukan oleh komposisi genetik dari seseorang dan berinteraksi dengan faktor-faktor eksternal, g ,termasuk nutrisi, psikososial dan faktor ekonomi
3
![Page 4: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/4.jpg)
Fase-fase pertumbuhan normal
Pertumbuhan terjadi pada kecepatan b b d b d lberbeda-beda selama masa :- Intra uterine- Masa awal dan pertengahan Childhood dan- Masa adolescenePertumbuhan pre-natal rata-rata 1,2-1,5 cm/minggu
4
![Page 5: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/5.jpg)
Midgestational length growth velocity dari 2,5 / i t j di 0 5 / icm/minggu turun menjadi 0,5 cm/minggu,
segera akan lahirK t t b h t t ± 15Kecepatan pertumbuhan rata-rata ± 15 cm/tahun, selama 2 tahun pertama kehidupan dan perlahan menjadi 6 cm/tahunkehidupan, dan perlahan menjadi 6 cm/tahun selama middlle childhood
5
![Page 6: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/6.jpg)
Growth Retardation (GR)
GR diklasifikasikan sbb:I. Primary Growth Abnormalities
A. OsteochondrodysplasiaB. Chromosomal abnormalitiesC. Intra Uterine Growth Retardation
6
![Page 7: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/7.jpg)
II. Secondary Growth DisordersA. MalnutritionB. Chronic DiseaseC. Endocrine Disorders
7
![Page 8: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/8.jpg)
Sambungan. . . . .
C. Endocrine Disorders1. Hypothyroidism2. Cushing’s Syndrome3. Pseudohypo Parathyroidism4. Rickets a vitamin D resistant rickets5. IGF deficiensy
a. GHD due to Hypothalamic dysfunction
8
yp yb. GHD due to pituitary GH deficiency
![Page 9: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/9.jpg)
Sambungan. . . . .
c. GH resistance1. Primary GH insensitivity2. Secondary GH insensitivity
d. Primary defects of IGF transport& clearancee. IGF Insensitivityy
1. Defect of the type I/GF receptor2. Post receptor defect
9
pIII. Idiopathic Short Stature
![Page 10: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/10.jpg)
Excess Growth and Tall Stature
Fetal IGF IIPost natal Excess GH secretionHyperthyroidismHyperthyroidismAdult androgen or estrogen deficiencyTesticular feminizationTesticular feminizationExcess GH
10
![Page 11: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/11.jpg)
11
![Page 12: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/12.jpg)
Hypothyroidism
Hypothyroidism is the disease caused by i ffi i t d ti f th id h binsufficient production of thyroid hormone by the thyroid gland. C ti i i f f h th idi f dCretinism is a form of hypothyroidism found in infants.
12
![Page 13: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/13.jpg)
How To Diagnostic Hypothyroidism ?
To diagnose hypothyroidism, – TSH↑ FT4↓ Primary Hipothyroidism– TSH↑, FT4↓ Primary Hipothyroidism– TSH↓, FT4↓, FT3 N ↓ Secondary Hipothyroidism– TSH↓, FT4 N, FT3↓ Secondary Hipothyroidism
Suppression of thyrotropin-releasing hormon ( TRH )– Suppression of thyrotropin-releasing hormon ( TRH )( Tertiary Hipothyroidism )
If the TSH is normal and hypothyroidism is still suspected blood testing ;suspected. blood testing ;
– Free triiodothyronine (fT3)– Free levothyroxine (fT4)
Total T3
13
– Total T3 – Total T4
![Page 14: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/14.jpg)
The following measurements may be needed:
24 hour urine free T3 Antithyroid antibodies for evidence of autoimmuneAntithyroid antibodies — for evidence of autoimmune diseases that may be damaging the thyroid gland Serum cholesterol — which may be elevated in h h idihypothyroidism Prolactin — as a widely available test of pituitary function Testing for anemia, including ferritin Basal body temperature
14
![Page 15: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/15.jpg)
15
![Page 16: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/16.jpg)
Hipotiroid (FF), Laboratorium- T3 menurun- T4 menurun- TSH normalHipertiroid :- T3 meningkat → T3 Tirotoksikosis- T4 meningkat → T4 Tirotoksikosis
16
g
![Page 17: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/17.jpg)
17
![Page 18: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/18.jpg)
Pendekatan untuk penderita Hypothyroidism (FF)Hypothyroidism (FF)
Sign/symtoms HypothyoridismYes
TSH LevelFT4 or FT4I
TSH FT4 or FT4I
TSH (N) or FT4 or FT4I
TSH (N)FT4(N) or FT4I(N)
TSH FT4(N) or FT4I(N)
PrimaryHypothyroidism
Consider CentralHypothyroidism
Consider otherCauses of patientsSubclinical
Hypothyroidism
18
Hypothyroidism Hypothyroidism Sign & symtomsHypothyroidism
![Page 19: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/19.jpg)
Sign & Symtoms Hypothyroidism
Weakness Weight gainWeaknessDry skinEdema Eye Lids
Weight gainLoss of hairAnorexiaEdema Eye Lids
Cold skinMemory ⇓
AnorexiaNervousnessSweating ⇓Memory ⇓
ConstipationSweating ⇓Parasthesia
19
![Page 20: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/20.jpg)
Hyperthyroidism
Hyperthyroidism is the term for overactive ti ithi th th id l d lti itissue within the thyroid gland, resulting in overproduction and thus an excess of circulating free thyroid hormones: thyroxinecirculating free thyroid hormones: thyroxine (T4), triiodothyronine (T3), or both
20
![Page 21: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/21.jpg)
How To Diagnostic Hyperthyroidism ?
TSH↓, FT4↑ Hiperthyroidism.E i i did i t k– Excessive iodide intake
– Overmedication chronic oral thyroxineGraves’ desease / toxic goiter– Graves desease / toxic goiter
TSH↓, FT4 normal, FT3↑ ThyrotoxicosisTSH↑, FT4 ↑ TSH secreting tumorTSH↑, FT4 ↑ TSH secreting tumoranti-TSH-receptor antibodies anti-thyroid-peroxidase
21
y p
![Page 22: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/22.jpg)
Pendekatan untuk penderita Hyperthyroidism
Sign/symtoms Hyperthyoridism
TSH LevelYes
TSH LevelFT4 or FT4I
TSH TSH TSH (N)TSHTSH FT4 or FT4I
TSH FT4 or FT4I
TSH (N)FT4(N) or FT4I(N)
TSH FT4(N) or FT4I(N)
Hyperthyroidism Consider TSH Consider otherT3yp y Consider TSHProducingAdenoma
Consider otherCauses of patientsSign & symtoms
T3
N
S b li i l
Diffuse goiter + bruitOpthalmopathy
Pretibial oedemaSubclinical
Hiperthyroid T3 Thyrotoxicosis
Yes No
Gvave P f
22
GvaveDisease
PerformRadioactive
IodineUptake test
![Page 23: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/23.jpg)
Sign & Symptoms Hyperthyroidism
NervousnessEmotional lability
DiarrheaProx Muscle weaknessEmotional lability
TremorPalpitations
Prox. Muscle weaknessHeart intoleranceMoist skinPalpitations
FatigueWeight loss
Moist skinFine hairHair loss
TachycardiaAtrial Fibrilasi
WeaknessIncrease appetite
23diff systole &
diastole BP
![Page 24: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/24.jpg)
Cushing's syndrome
Cushing's syndrome (hyperadrenocorticism or hypercorticism) is a hormone (endocrine) disorderhypercorticism) is a hormone (endocrine) disorder caused by high levels of cortisol (hypercortisolism) in the blood. There are several possible causes of Cushing'sThere are several possible causes of Cushing's syndrome.
– Hormones that come from outside the body are called exogenous ( l ti id d )exogenous (glucocorticoid drugs )
– hormones that come from within the body are called endogenous. (tumors that produce cortisol or adrenocorticotropic hormone (ACTH). )
24
hormone (ACTH). )
![Page 25: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/25.jpg)
The paraventricular nucleus (PVN) of the h th l l ti t i l ihypothalamus releases corticotropin-releasing hormone (CRH) Pituitary gland to release adrenocorticotropin (ACTH) Adrenal glandadrenocorticotropin (ACTH) Adrenal gland (zona fasciculata ) (cortisol).Elevated levels of cortisol exert negativeElevated levels of cortisol exert negative feedback on the pituitary.
25
![Page 26: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/26.jpg)
Laboratory Diagnostic
Dexamethasone suppression test 24-hour urinary measurement for cortisol Cortisol in saliva over 24 hours
26
![Page 27: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/27.jpg)
Cushing Syndrome (CS)
CS results prolong Exposure to excessive p g pamounts of endogenous or exogenous corticosteroidsKadar Cortisol plasma lebih besar dari 7 ug/dl (200nmol/L) pada midnightOrgan normal :- Paling tinggi pagi hari, malam meningkat
27sedikit (2ug/dl)
![Page 28: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/28.jpg)
Sambungan. . . . .
- False positif : Stress (vena puncture),Penyakit berulang-ulang, takut
Free Cortisol urin :- Metabolisme cortisol di urin :
17 hydrocorticosteroid atau17 exogenicsteroid
- Normal 80-120 ug/24 jam
28
g j- Bisa normal 8-15% penderita
![Page 29: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/29.jpg)
Dexamethazon Suppression Test
1 mg dexamethazon diberi tengah malamPada jam antara 08-09, bila response normal kadar plasma cortisol < 5 ug/dl
Cushing Syndromeg yACTH dependentACTH independent
29
ACTH independent
![Page 30: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/30.jpg)
Kadar ACTH antara 11.00-01.00 PM> 23 pg/dl → ACTH dependentPemeriksaan ACTH dgn ImunoradiometricKlinis : - Centripetal Obesity + Buffalo Hump
- Moonface- Hirsutism
30
![Page 31: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/31.jpg)
Cushing’s Syndrome
Sign & Symtoms Present
Perform Screening test for CSSyndrome Perform Screening test for CS24 hours urin collection for
Cortisol or Over night 1 mg DST
24 hours urin Cortisol Perform over night 1 mg DST
Cortisol > 5 ug/dlCortisol (N) Cortisol ↑ Cortisol ↑ > 3 5X Cortisol > 5 ug/dl
Cushing’s Syndromel
Cortisol (N) Cortisol ↑But not > 3.5X
Upper limit normalConsider
Alternative
Cortisol ↑ > 3.5XUpper limit normal
Futher evaluation Cushing’s
Plasma ACTH
Alternativediagnosis
Futher evaluationTo differentiateCushing’s frompseudocushing
Cushing sSyndrome
>10-15 pg/dl⇓A
Perform one of the following:-Dexamethazon-CHR test-Midnight serum cortisolLate night salivary cortisol
A
< 5 pg/dl, considerAdrenal causes of CS
31
-Late night salivary cortisol
Results consistentwith Cushing’s
Results consistent withpseudocushing’sStop
Perform CT / MRIAdrenal Gland
![Page 32: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/32.jpg)
A. Plasma ACTH
Plasma ACTHPlasma ACTH
> 10-15 pg/dl
Perform High Dose DST(8 mg Dexamethazon)
Ectopic ACTHC hi ’
Suppression (+) Suppression (-)
Ectopic ACTHScreening
tumor
Cushing’sDisease
32
![Page 33: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/33.jpg)
Sign & Symtoms CS
Central Obesity AcneyProximal Muscle Weakness(hips,shoulders)
HyperpigmentasionHirsutism(male-pattern hair
Hypertensionbuffalo hump moon face
growth in a female) HyperglicemiaHypokalmic metabolikmoon face Hypokalmic metabolik Acidosis
33
![Page 34: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/34.jpg)
Pseudo hypoparathyroid
Hipercalcemic LaboratoriumHiperphosphatemicKlinis :
Laboratorium
- Short stature- Rounded face Albright’s- Obesitas- Subcutan Calcification
gHereditary
Osteodystrophy(AHO)
34- Shortened fourth metacarpal (AHO)
![Page 35: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/35.jpg)
Rickets
Gangguan mineralisasi dari organik matrikGangguan mineralisasi dari organik matrik tulangAnak-anak gangguan terjadi pada :a a a ga ggua te jad pada- Growth plate- Mineralisasi kartilago → terjadi deformitasMineralisasi kartilago → terjadi deformitas
35
![Page 36: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/36.jpg)
36
![Page 37: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/37.jpg)
Vitamin D is required for proper calcium b ti f th t I th b fabsorption from the gut. In the absence of
vitamin D, dietary calcium is not properly absorbed resulting in hypocalcemia leadingabsorbed, resulting in hypocalcemia, leading to skeletal and dental deformities and neuromuscular
37
![Page 38: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/38.jpg)
Laboratorium (Rickets)
Infants dengan Vit. D Deficiencyg ySerum Calcium selalu rendahSerum Phosphat batas normalSerum Phosphat batas normalserum alkaline phosphatase meningkat
38
![Page 39: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/39.jpg)
Di d f th Pit it &Disorder of the Pituitary & Hypothalamus
Anterior Pituitary mensintesa :- Growth Hormon- Prolactin- TSH- FSH- LH
Hypothalamus mensekresi tropik hormon
39
Hypothalamus mensekresi tropik hormon untuk masing-masing
![Page 40: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/40.jpg)
Pituitary hormon excess
ProlactinomaProlactinomaCushing;s SyndromeAcromegaly and GigantismAcromegaly and GigantismTSH Secreting Adenoma
40
![Page 41: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/41.jpg)
Pituitary hormon deficiency
HypoadrenalismHypothyrodismHypothyrodismHypogonadismSomatomedin deficiency (IGF Deficiency)Somatomedin deficiency (IGF Deficiency)
41
![Page 42: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/42.jpg)
L b t t t f di i fLaboratory tests for diagnosis of disorders of pituitary and hypothalamus
Growth Hormon (GH)Dih ilk & di k i l h it it t tDihasilkan & disekresi oleh pituitary somatotropecells sebagai respons terhadap GHRH hypotha-llamus Effek kerja dimediasi melalui Insulin Like GrowthFaktor (IGF)Faktor (IGF)Kegunaan : - Differential diagnosis :
Short Stature Slow Growth
42
Short Stature, Slow Growth- Evaluasi Pituitary Function
![Page 43: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/43.jpg)
Insulin-like growth factor
Regulation of growth and development in lmammals.
Stimulation of cellular proliferation and th IGF I h i t t ff tgrowth, IGF-I has important effects on
carbohydrate, protein and bone metabolism
43
![Page 44: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/44.jpg)
Meningkat
Acromegaly, karena adenoma pituitary tertentuLaron dwarfism (kekurangan GH receptor)GH resistanceRenal FailureUncontrol DMObat-obatan : Estrogen, Kontrasepsi oralStravation
442 jam sesudah tidur
![Page 45: Gds137 Slide Pemeriksaan Laboratorium Dan Interprestasi Pada Growth Retardation Tiroid2](https://reader033.vdocuments.site/reader033/viewer/2022042516/55cf96ce550346d0338de42f/html5/thumbnails/45.jpg)
Menurun
Gangguan pada hypothalamus (tumor, i f k i h k t i )infeksi, hemokromatosis)Hypopituitarism (tumor, infeksi, granuloma,
di i)radiasi)DwarfismC ti t id thCorticosteroid therapyObesity
45