ht ped endocrine dis skill lab 11

8/18/2019 Ht Ped Endocrine Dis Skill Lab 11

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ISTORY TAKING IN

ISTORY TAKING IN

PEDIATRIC ENDOCRINEEDIATRIC ENDOCRINE

DISEASE

ISEASE


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DEFINITION

EFINITION

The term short stature describes heightThe term short stature describes height

that is in the third percentile as comparedthat is in the third percentile as compared

to the average height for a person’s age,to the average height for a person’s age,sex, and racial groupsex, and racial group


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Causes

auses

Normal variantsNormal variants

Non-endocrine causesNon-endocrine causes

Endocrine causesEndocrine causes


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CAUSES OF SHORT STATURECAUSES OF SHORT STATURE

Nonendocrine CausesNonendocrine CausesConstitutional short statureConstitutional short stature

Genetic short statureGenetic short stature

Intrauterine growth retardation and SGAIntrauterine growth retardation and SGA

Syndrome of short statureSyndrome of short stature

Turner’s syndrome and its variantsTurner’s syndrome and its variants

oonan’s syndrome !"seudo#Turner’s syndrome$oonan’s syndrome !"seudo#Turner’s syndrome$

"rader#%illi syndrome"rader#%illi syndrome

&aurence#'oon and (ardet#(iedl syndrome&aurence#'oon and (ardet#(iedl syndrome

)ther autosomal abnormalities * dysmorphic synd)ther autosomal abnormalities * dysmorphic synd

Chronic diseaseChronic disease

# Cardiac disorder # Cardiac disorder

&eft to right shunt&eft to right shunt

Congestive heart failureCongestive heart failure

# "ulmonary disorders# "ulmonary disorders

Cystic fibrosisCystic fibrosis

Asthma Asthma

# Gastrointestinal disorders# Gastrointestinal disorders

'alabsorption !eg, celiac disease$'alabsorption !eg, celiac disease$

+isorders of swallowing+isorders of swallowing

# epatic disorders# epatic disorders

# ematologic disorders# ematologic disorders

Sic-le cell anemiaSic-le cell anemia

ThalassemiaThalassemia

# .enal disorders# .enal disorders

.enal tubular acidosis.enal tubular acidosis

Chronic uremiaChronic uremia

# Immunologic disorders# Immunologic disorders

Connective tissue diseaseConnective tissue disease

/uvenile rheumatoid arthritis/uvenile rheumatoid arthritis

Chronic infectionChronic infection

# Central nervous system disorders# Central nervous system disorders

# 'alnutrition# 'alnutrition

+ecreased availability of nutrients+ecreased availability of nutrients

0ad diets0ad diets

1oluntary dieting1oluntary dieting

Anorexia nervosa Anorexia nervosa

Anorexia of cancer chemotherapy Anorexia of cancer chemotherapy

Endocrine disordersEndocrine disordersG deficiency and variantsG deficiency and variants

# Congenital G deficiency# Congenital G deficiency

# %ith midline defects# %ith midline defects

# %ith other pituitary hormone deficiencies# %ith other pituitary hormone deficiencies

# Isolated G deficiency# Isolated G deficiency

# "ituitary agenesis# "ituitary agenesis

# Ac2uired G deficiency# Ac2uired G deficiency

ypothalamic#pituitary tumorsypothalamic#pituitary tumors

istiocytosis 3istiocytosis 3

Central nervous system infectionsCentral nervous system infections

ead in4uriesead in4uries

G deficiency following cranial irradiationG deficiency following cranial irradiation

Central nervous system vascular accidentsCentral nervous system vascular accidents

ydrocephalusydrocephalus

5mpty sella syndrome5mpty sella syndrome

# Abnormalities of G action# Abnormalities of G actionG insensitivity !&aron’s dwarfism$G insensitivity !&aron’s dwarfism$

"rimary IG0#6 deficiency"rimary IG0#6 deficiency

IG0 receptor defectIG0 receptor defect

"sychosocial dwarfism"sychosocial dwarfism

ypothyroidismypothyroidism

Glucocorticoid excess !Cushing’s syndrome$Glucocorticoid excess !Cushing’s syndrome$

5ndogenous5ndogenous

5xogenous5xogenous

"seudohypoparathyroidism"seudohypoparathyroidism

+isorders of vitamin + metabolism+isorders of vitamin + metabolism

+iabetes mellitus, poorly treated+iabetes mellitus, poorly treated

+iabetes Insipidus, poorly treated+iabetes Insipidus, poorly treated


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0amilial !genetic$ short stature and0amilial !genetic$ short stature andconstitutional short stature are commonconstitutional short stature are commonvariations of normalvariations of normal77

Individuals with familial short stature have aIndividuals with familial short stature have anormal growth rate even though it is below thenormal growth rate even though it is below the8th percentile8th percentile

They do not have s-eletal delay, puberty andThey do not have s-eletal delay, puberty and

pubertal growth spurt occur at the usualpubertal growth spurt occur at the usualchronological age, and final height ischronological age, and final height isappropriate for mid#parental target heightappropriate for mid#parental target height


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Those with constitutional short stature have growthThose with constitutional short stature have growthdeceleration in the first two years of life, with normaldeceleration in the first two years of life, with normalgrowth velocity being achieved by age three andgrowth velocity being achieved by age three andcontinuing throughout childhoodcontinuing throughout childhood

)nset of puberty is usually delayed)nset of puberty is usually delayed Adult height is in the normal range but varies according Adult height is in the normal range but varies according

to parental heightto parental height


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Non-eno!rine !auses

on-eno!rine !auses

on#endocrine causes of short stature are commoner than endocrineon#endocrine causes of short stature are commoner than endocrinecausescauses

"atients with non#endocrine disease tend to have normal body"atients with non#endocrine disease tend to have normal bodyproportionsproportions

Chronic malnutrition is the commonest cause of poor growth globally 9Chronic malnutrition is the commonest cause of poor growth globally 9

inflammatory bowel disease, coeliac disease, or anorexia nervosainflammatory bowel disease, coeliac disease, or anorexia nervosa Short stature is also commonly associated with renal disease, andShort stature is also commonly associated with renal disease, and

conditions associated with hypoxia or hypoxaemia, such as congenitalconditions associated with hypoxia or hypoxaemia, such as congenitalheart disease, pulmonary disease, and haemoglobinopathiesheart disease, pulmonary disease, and haemoglobinopathies

""sychosocial deprivation often causes short stature7 "lacing the child in asychosocial deprivation often causes short stature7 "lacing the child in adifferent environment results in growth catching up7different environment results in growth catching up7


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Eno!rine !ausesEno!rine !auses

Growth hormone deficiency or insufficiency is an uncommonGrowth hormone deficiency or insufficiency is an uncommoncause of short staturecause of short stature

"revalence of the condition 96 in :;;;"revalence of the condition 96 in :;;; Classic G deficiency 9 short stature, increased fat mass leadingClassic G deficiency 9 short stature, increased fat mass leading

to a


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Eno!rine !ausesEno!rine !auses

The impairment of growth in Cushing>sThe impairment of growth in Cushing>ssyndrome is predominantly the result of asyndrome is predominantly the result of a

direct effect at the growth plate7 Thedirect effect at the growth plate7 Thecommonest cause is iatrogeniccommonest cause is iatrogenic!treatment with glucocorticoids$, with!treatment with glucocorticoids$, withendogenous glucocorticoid excessendogenous glucocorticoid excess

!Cushing>s syndrome dependent on the!Cushing>s syndrome dependent on thepituitary and adrenal glands$ being muchpituitary and adrenal glands$ being muchrarer7rarer7


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Causes

auses

Several factors contribute to short stature, including9Several factors contribute to short stature, including9 Genetic factors !eg, s-eletal dysplasias,Genetic factors !eg, s-eletal dysplasias, Turner syndromeTurner syndrome,, +own’s syndrome+own’s syndrome,,

Silver .ussell syndrome$Silver .ussell syndrome$ 5ndocrine disorders !eg,5ndocrine disorders !eg, hypothyroidismhypothyroidism,, growth hormone deficiency$growth hormone deficiency$ +elayed puberty !causes temporary short stature, but normal height is eventually+elayed puberty !causes temporary short stature, but normal height is eventually

achieved$achieved$ 5arly puberty5arly puberty 'alnourishment !on a global scale, this is the most common cause of growth'alnourishment !on a global scale, this is the most common cause of growth

failure and is generally associated with poverty$failure and is generally associated with poverty$ Chronic diseases9Chronic diseases9

Congenital heart diseaseCongenital heart disease ?idney diseases?idney diseases

Asthma Asthma Sic-le cell anemiaSic-le cell anemia Gastrointestinal disorders !eg,Gastrointestinal disorders !eg, inflammatory bowel disease$inflammatory bowel disease$ &ung conditions ! cystic fibrosis, severe&ung conditions ! cystic fibrosis, severe asthma, chronic obstructive pulmonaryasthma, chronic obstructive pulmonary

disease$disease$

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ISTORY TAKING

ISTORY TAKING

1.1. Initiating the sessionInitiating the session# Greeting, Introduce, obtain patient’s name, sex, date of birth, and# Greeting, Introduce, obtain patient’s name, sex, date of birth, and

Address Address

2.2. Identifying the reason for the consultationIdentifying the reason for the consultation 99

## Chief complainChief complain## 5xplanation about hystory ta-ing5xplanation about hystory ta-ing

3.3. Gathering informationGathering information# istory of present illness# istory of present illness # "regnancy# "regnancy

# (irth istory# (irth istory # istory of +evelopment# istory of +evelopment# 0amily istory# 0amily istory # istory of +isease# istory of +isease

# 'edications# 'edications # +iet# +iet

# Accidents# Accidents # Social# Social

:7:7 ClosingClosing


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istor" o# $resent

istor" o# $resent

illnessllness

The onsetThe onset

)ther symptom!s$)ther symptom!s$


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Pre%nan!"

re%nan!"

utritional statusutritional status

Toxic or medication exposureToxic or medication exposure

Gestational ageGestational age


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&irt' istor"

irt' istor"

+elivery+elivery

A"GA. score A"GA. score

(irth weight * length(irth weight * length


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istor" o# Develo$ment

istor" o# Develo$ment

Age of milestone 9 Age of milestone 9 sitting, wal-ing, spea-ingsitting, wal-ing, spea-ingwordswords

5ducational achievement5ducational achievement


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Famil" istor"

amil" istor"

0amily member with short stature0amily member with short stature

ConsanguinityConsanguinity

eight and weight of siblingseight and weight of siblings

eight and weight of parentseight and weight of parents

"uberty"uberty


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istor" o# Disease

istor" o# Disease

GastrointestinalGastrointestinal

&ung&ung

earteart

?idney disease?idney disease

Anemia Anemia


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(ei!ations

ei!ations

CorticosteroidsCorticosteroids


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DIET

IET

Ade2uate food !2uantity$ Ade2uate food !2uantity$

@uality !healthful$@uality !healthful$


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A!!ients

!!ients

eadead


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SOCIA)

OCIA)

ome 9ome 9 interactioninteraction

School 9School 9 interrelationship with schoolmatesinterrelationship with schoolmates


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ht ped endocrine dis skill lab 11

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