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  #1  
Old 08-23-2016
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Default Qbank question help

I have attached the question stem here.
Can anyone tell me how you DDx growth hormone deficiency and constitutional delay of growth from the stem?

Thanks!
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  #2  
Old 08-23-2016
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This is a summary of what I read on UpToDate.

Based on this question stem two characteristics jump out:
1) The child's history is unremarkable, she doesn't have any other presenting symptoms other than short stature.
2) Her parents are of normal height.

While both constitutional and GH deficiency can result in decreased growth velocity as you have noted, the fact that the child does not have any signs of hypoglycemia, central obesity, or any types of endocrine abnormalities would rule out GH deficiency.

Additionally, with constitutional, the child will have short stature, but as they enter adulthood, their stature is consistent with the population's average height. It is common for their parents to be of normal stature.

Let me know if that answered your question! It is a good one and I'm happy to look into more detail if that has not cleared it up.
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Old 08-24-2016
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Quote:
Originally Posted by ignitedstudent View Post
This is a summary of what I read on UpToDate.

Based on this question stem two characteristics jump out:
1) The child's history is unremarkable, she doesn't have any other presenting symptoms other than short stature.
2) Her parents are of normal height.

While both constitutional and GH deficiency can result in decreased growth velocity as you have noted, the fact that the child does not have any signs of hypoglycemia, central obesity, or any types of endocrine abnormalities would rule out GH deficiency.

Additionally, with constitutional, the child will have short stature, but as they enter adulthood, their stature is consistent with the population's average height. It is common for their parents to be of normal stature.

Let me know if that answered your question! It is a good one and I'm happy to look into more detail if that has not cleared it up.
Hi,
Thanks for the reply but the answer is actually GH deficiency and not constitutional delay of growth. What you said all made sense and that was why I picked constitutional delay but got it wrong.
Any other suggestions?
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Old 08-25-2016
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Quote:
Originally Posted by Step-One View Post
Hi,
Thanks for the reply but the answer is actually GH deficiency and not constitutional delay of growth. What you said all made sense and that was why I picked constitutional delay but got it wrong.
Any other suggestions?
I got nothing. My only other thought was onset of short stature, but that wouldn't distinguish between the two either. Seems like your logic was spot on? Time to page the endocrinologist.
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Old 08-26-2016
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In constitutional growth delay the child will be below the 3rd percentile of growth velocity right from the beginning and will later show a period of rapid catch-up growth. Also, their bone age will be consistent with chronological age.

In this pt., we have a bone age of only 1 year in a 3 year old child plus we have child who was initially above 50th percentile and then started falling and went below 3rd percentile. Both these things are consistent with an organic cause for the growth delay, one of which is GH deficiency.
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