SOME PEARLS FOR YOU: 1. A normal growth rate along with a percentile consistent with parental heights suggests familial short stature 2. A normal growth rate along a lower percentile with a delayed bone age (BA < CA) suggests constitutional delay 3. Underweight for low height suggests a systemic illness or malabsorption. Get labs (CBC, BMP, ESR, anti-EM antibodies) 4. Overweight for low height suggests an endocrine disorder. Get TSH, T4, IGF-1, and 24-hr urine cortisol. 5. Consider a genetic syndrome if the patient has dysmorphic features. Especially Turner's in a young girl (karyotype).
(On Friday of March 17, 2023). On the Matter of Case Study 42 on a 11-Year-Old-Male (Child) with Possible Growth Failure (By MD Paul Bolin: CRASH! Medical Review Series): 1) Vitals: All WNL; 2) Growth Charts Tracking the Subject at 2nd and 3rd Percentiles on Height (4'3") and Weight (58 lbs) Parameters; 3) Obstetrics/Gynecological History is Normal for Prenatal, Birth and Postnatal. All Developmental Milestones so far are Normal; Subject has no Siblings; and Father was marked by a Protracted Development (Post Pubertal Growth Spurt); 4) Physical Examination (Px); 1) General is NAD and Well-Developed; 2) Lymph Nodes are Normal (LAN Negative); 3) HEENT: 1) Atraumatic Normocephalic, PERRLA, Conjunctival Pallor Negative, Clear Auditory Canal, Normal Tympanic Membrane, Normal Mucosa (Oral and Pharyngeal), and Supple Neck; 4) Chest/Lung CTA; 5) CV is RRR and Absence of Murmurs; 6) Abdomen is NT/ND, NBS, and Spleen/LIver Unpalpable; 7) Genitals are Descended Bilaterally and Tanner Stage I (Pre-Adolescent Testes [≤2.5 cm]) and Sparse Public Area Keratinization; 8) Extremities are Full ROM, Cyanosis Negative, Digital Clubbing Negative, Edema Not Seen, Symmetric Pulses, and Proportionate (Dysmelia Negative); 8) Neurological is Grossly Non-Focal (A Walking, Talking, and Moving Subject with All Extremities in a Normal Fashion, Without Any Obvious Neurological Impairment); otherwise Neurologically Sound; 5) Differential Diagnosis (DDx): 1) Constitutional Growth Delay (Normal Finding without Medical or Genetic Aetiology Suspicion); 2) Familial Short Stature (Inheritance of Short Phenotype); 3) Idiopathic Short Stature (Diagnosis Of Exclusion made After Reasonable Examination and Negative Findings Therein); 4) Failure to Thrive (FTT) is Faltering in Weight (Malnutrition, or Medical Reasons) whereas Derivational Short Stature (Psychosocial Short Stature Disorder); 5) Endocrine Aetiology: 1) Growth Hormone Deficiency; 2) Hypothyroidism; 3) Craniopharyngioma (SSx of Headache, Vision Problems, Fatigue, Polyuria [Diabetes Insipidus], Hypogonadism) and Tx via Excision (Resection) and Bleomycin, and Radiation Therapy; 4) Pseudohypoparathyroidism (High PTH, Short Stature, Hypocalcemia and Hyperphosphatemia, Facies (Moon or Round), Short Neck, Bones of Hand and Digits [Osteodystrophy]) with a Genetic Aetiology (AD and GNAS 1 Gene Variation); Lifelong Supplementation of Calcium and Vitamin D (Cholecalciferol); 6) Genetic Aetiology: 1) Short Stature Homeobox (SHOX) Gene Mutation. GH Therapy And/or Supplementation Responsive; 2) Down Syndrome (Trisomy 21), 3) Turner Syndrome is Gonadal Dysgenesis affecting Females only (Monosomy X or 45 X [45 X0]); 7) And Lastly, Short Stature Due to Chronic Illness; 6) Diagnosis (Dx): 1) Initial Diagnostic Investigations via Growth Chart (GC) Review; GC Herein Indicates Low Percentile Growth but Steady and Progressive (No Weight Deterioration or Height Decreases) otherwise Linear Growth; 2) Bone Age Radiography (X-Ray Imaging of Left Hand/Wrist Locus) to determine Maturity of Bone; BA is Aged for Structural and Biological Maturity of a 9 Year-Old-Age (Metacarpal-Phalangeal Growth Plates and Bone Mineralization Estimation). Given Chronological Age is 11 this is pathognomonic of Constitutional Growth Delay; 5) Therefore, No Pathology Identified. Diagnosis is Constitutional Growth Delay; 7) Management (Mx): 1) Reassure Family and Subject of the Physiologic Function and Benignity of Process; 2) Follow up within One Year; 3) Recommendation of a Healthy (Well-Balanced Diet) Macromolecule and Trace Mineral Intake to Avoid the Possibility of a Medical Aetiology Transformation (Rickets, Marasmus, Kwashiorkor or Nutriopenia); 8) Pathology of Constitutional Growth Delay is not Evident or Suggested due to Variation in Growth Rates provided Linear Growth and Evidence of Velocity/Rate of Growth is Sustained. Herein History (Hx; Parents are Not of Short Phenotype) and Physical Examination (Px; was completely Normal) revealed no Indications of Possible Medical and Genetic Aetiologies of Growth Delay, Puberty Anomaly or the Short Stature. One Possible way to Estimate or Predict Height of Peak Development is a Formula of Parents Height in Inches and adding 6 for Males and Substration 6 for Females and the Dividing this Sumation by two (2). The Resulting Product can be a Prognostic Height of Peak Development; Goodness, My First Assessment of Developmental Rates. Not Really. Just Kidding. My Subject had hints of Psychosocial Short Stature and was Successfully Reversed with Recombinant Human Growth Hormone along the Lines of HRT of the Nouvelle Type. MD Paul W. Bolin, es geht sehr gut aber man muss weiter aufbauen. Heil!
Yes. Remember that velocity is change in distance (in this case, height) over time. So it's the slope of the growth curve. A kid's growth should be parallel to the curve. If you start changing percentiles, that suggests a medical issue. Whereas if you're tracking in the same percentiles, it suggests a genetic cause (including familial short stature) or constitutional delay (which is suspected when the bone age is less than the chronological age).
![[UNCUT] เก็บ "สจ.โต้ง" เอี่ยวมาเฟีย รู้ตัวคนบงการ ก่อนสั่งลั่นไก I คนดังนั่งเคลียร์ I 13 ธ.ค.67](http://i.ytimg.com/vi/o-J_p62D40w/mqdefault.jpg)
SOME PEARLS FOR YOU:
1. A normal growth rate along with a percentile consistent with parental heights suggests familial short stature
2. A normal growth rate along a lower percentile with a delayed bone age (BA < CA) suggests constitutional delay
3. Underweight for low height suggests a systemic illness or malabsorption. Get labs (CBC, BMP, ESR, anti-EM antibodies)
4. Overweight for low height suggests an endocrine disorder. Get TSH, T4, IGF-1, and 24-hr urine cortisol.
5. Consider a genetic syndrome if the patient has dysmorphic features. Especially Turner's in a young girl (karyotype).
THANKS FOR YOUR EFFORT.. INFORMATIVE
Thank you so much:)
very interesting, thanks for the video! :)
(On Friday of March 17, 2023). On the Matter of Case Study 42 on a 11-Year-Old-Male (Child) with Possible Growth Failure (By MD Paul Bolin: CRASH! Medical Review Series): 1) Vitals: All WNL; 2) Growth Charts Tracking the Subject at 2nd and 3rd Percentiles on Height (4'3") and Weight (58 lbs) Parameters; 3) Obstetrics/Gynecological History is Normal for Prenatal, Birth and Postnatal. All Developmental Milestones so far are Normal; Subject has no Siblings; and Father was marked by a Protracted Development (Post Pubertal Growth Spurt); 4) Physical Examination (Px); 1) General is NAD and Well-Developed; 2) Lymph Nodes are Normal (LAN Negative); 3) HEENT: 1) Atraumatic Normocephalic, PERRLA, Conjunctival Pallor Negative, Clear Auditory Canal, Normal Tympanic Membrane, Normal Mucosa (Oral and Pharyngeal), and Supple Neck; 4) Chest/Lung CTA; 5) CV is RRR and Absence of Murmurs; 6) Abdomen is NT/ND, NBS, and Spleen/LIver Unpalpable; 7) Genitals are Descended Bilaterally and Tanner Stage I (Pre-Adolescent Testes [≤2.5 cm]) and Sparse Public Area Keratinization; 8) Extremities are Full ROM, Cyanosis Negative, Digital Clubbing Negative, Edema Not Seen, Symmetric Pulses, and Proportionate (Dysmelia Negative); 8) Neurological is Grossly Non-Focal (A Walking, Talking, and Moving Subject with All Extremities in a Normal Fashion, Without Any Obvious Neurological Impairment); otherwise Neurologically Sound; 5) Differential Diagnosis (DDx): 1) Constitutional Growth Delay (Normal Finding without Medical or Genetic Aetiology Suspicion); 2) Familial Short Stature (Inheritance of Short Phenotype); 3) Idiopathic Short Stature (Diagnosis Of Exclusion made After Reasonable Examination and Negative Findings Therein); 4) Failure to Thrive (FTT) is Faltering in Weight (Malnutrition, or Medical Reasons) whereas Derivational Short Stature (Psychosocial Short Stature Disorder); 5) Endocrine Aetiology: 1) Growth Hormone Deficiency; 2) Hypothyroidism; 3) Craniopharyngioma (SSx of Headache, Vision Problems, Fatigue, Polyuria [Diabetes Insipidus], Hypogonadism) and Tx via Excision (Resection) and Bleomycin, and Radiation Therapy; 4) Pseudohypoparathyroidism (High PTH, Short Stature, Hypocalcemia and Hyperphosphatemia, Facies (Moon or Round), Short Neck, Bones of Hand and Digits [Osteodystrophy]) with a Genetic Aetiology (AD and GNAS 1 Gene Variation); Lifelong Supplementation of Calcium and Vitamin D (Cholecalciferol); 6) Genetic Aetiology: 1) Short Stature Homeobox (SHOX) Gene Mutation. GH Therapy And/or Supplementation Responsive; 2) Down Syndrome (Trisomy 21), 3) Turner Syndrome is Gonadal Dysgenesis affecting Females only (Monosomy X or 45 X [45 X0]); 7) And Lastly, Short Stature Due to Chronic Illness; 6) Diagnosis (Dx): 1) Initial Diagnostic Investigations via Growth Chart (GC) Review; GC Herein Indicates Low Percentile Growth but Steady and Progressive (No Weight Deterioration or Height Decreases) otherwise Linear Growth; 2) Bone Age Radiography (X-Ray Imaging of Left Hand/Wrist Locus) to determine Maturity of Bone; BA is Aged for Structural and Biological Maturity of a 9 Year-Old-Age (Metacarpal-Phalangeal Growth Plates and Bone Mineralization Estimation). Given Chronological Age is 11 this is pathognomonic of Constitutional Growth Delay; 5) Therefore, No Pathology Identified. Diagnosis is Constitutional Growth Delay; 7) Management (Mx): 1) Reassure Family and Subject of the Physiologic Function and Benignity of Process; 2) Follow up within One Year; 3) Recommendation of a Healthy (Well-Balanced Diet) Macromolecule and Trace Mineral Intake to Avoid the Possibility of a Medical Aetiology Transformation (Rickets, Marasmus, Kwashiorkor or Nutriopenia); 8) Pathology of Constitutional Growth Delay is not Evident or Suggested due to Variation in Growth Rates provided Linear Growth and Evidence of Velocity/Rate of Growth is Sustained. Herein History (Hx; Parents are Not of Short Phenotype) and Physical Examination (Px; was completely Normal) revealed no Indications of Possible Medical and Genetic Aetiologies of Growth Delay, Puberty Anomaly or the Short Stature. One Possible way to Estimate or Predict Height of Peak Development is a Formula of Parents Height in Inches and adding 6 for Males and Substration 6 for Females and the Dividing this Sumation by two (2). The Resulting Product can be a Prognostic Height of Peak Development; Goodness, My First Assessment of Developmental Rates. Not Really. Just Kidding. My Subject had hints of Psychosocial Short Stature and was Successfully Reversed with Recombinant Human Growth Hormone along the Lines of HRT of the Nouvelle Type. MD Paul W. Bolin, es geht sehr gut aber man muss weiter aufbauen. Heil!
Perfect!
Is it (growth velocity) check’ng by growth table ?
Yes. Remember that velocity is change in distance (in this case, height) over time. So it's the slope of the growth curve. A kid's growth should be parallel to the curve. If you start changing percentiles, that suggests a medical issue. Whereas if you're tracking in the same percentiles, it suggests a genetic cause (including familial short stature) or constitutional delay (which is suspected when the bone age is less than the chronological age).