02 Kuliah Semester VI_2011_1
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Transcript of 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