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Old 08-19-2014
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Default short stature

trying to combine facts from KLN and MTB3 and it gets a bit confusing (kln p 39 and mtb3 p338, the tables on each book)

so here's what i think, correct any misunderstanding please or add and change any if needed

short stature --> take an xr to get the bone age:
1) CA > BA = constitutional, ptn will catch up, puberty will be delayed
decrease in weight = decrease in height (?)
Differential and labs from kln table"
systemic illness, genetic short stature and constitutional delay
labs: inflammatory markers, LFT creatinine BUN and electrolytes

2)CA=BA --> familial/genetic, puberty at normal time, ptn wont improve
what would the weight be like? from table in kln i'd say decrease in height and weight are equal? and the differential would be as above too

for both 1 and 2 i think i'd order endocrine related labs based on KLN mentioning endocrine in both sections (CA= BA and CA = BA, altho they are mentioned under normal weight gain in MTB_mind you, MTB listed both constitutional and genetic under decreased weight gain): TSH, T3 T4, 24 hour cortisol, IGF-1 and IGF-BP3)

3) ptn starts normal height then crosses the lines on the chart = pathological
diffrential: craniopharyngioma, hypothyroid, hypopituitrism


from MTB normal weight gain and decrease height: GH or thyroid deficiency, cushings, skeletal dysplasias, what would the chronological age and bone age be like?


Another thought is:
* based on KLN i'd order Xray first in short stature case
* based on MTB, i'd look at the weight first
which is correct?
im confused and sorry if the question is confusing
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sadaf1987 (08-24-2015)



  #2  
Old 08-19-2014
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Default

Quote:
Originally Posted by Faith-USMLE View Post
trying to combine facts from KLN and MTB3 and it gets a bit confusing (kln p 39 and mtb3 p338, the tables on each book)

so here's what i think, correct any misunderstanding please or add and change any if needed

short stature --> take an xr to get the bone age:
1) CA > BA = constitutional, ptn will catch up, puberty will be delayed
decrease in weight = decrease in height (?)
Differential and labs from kln table"
systemic illness, genetic short stature and constitutional delay
labs: inflammatory markers, LFT creatinine BUN and electrolytes

2)CA=BA --> familial/genetic, puberty at normal time, ptn wont improve
what would the weight be like? from table in kln i'd say decrease in height and weight are equal? and the differential would be as above too

for both 1 and 2 i think i'd order endocrine related labs based on KLN mentioning endocrine in both sections (CA= BA and CA = BA, altho they are mentioned under normal weight gain in MTB_mind you, MTB listed both constitutional and genetic under decreased weight gain): TSH, T3 T4, 24 hour cortisol, IGF-1 and IGF-BP3)

3) ptn starts normal height then crosses the lines on the chart = pathological
diffrential: craniopharyngioma, hypothyroid, hypopituitrism


from MTB normal weight gain and decrease height: GH or thyroid deficiency, cushings, skeletal dysplasias, what would the chronological age and bone age be like?


Another thought is:
* based on KLN i'd order Xray first in short stature case
* based on MTB, i'd look at the weight first
which is correct?
im confused and sorry if the question is confusing
If they give you an option to check the weight then you should get that first, it's going to be the most logical thing to do, get complete vitals before you start ordering tests.
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The above post was thanked by:
Faith-USMLE (08-19-2014)



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