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  #1  
Old 07-09-2012
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Kids Short Stature Question!

Parents of an 11-year-old girl bring her to the pediatrician concerned about her short stature. Her medical records document a height consistently in the lower 5th percentile and weight consistently in the lower 15th percentile. The patientís physical examination is completely normal. Which of the following would indicate constitutional delay, rather than genetic short stature, as the explanation for the girlís shortness?

A. Bone age consistent with height age
B. Growth hormone level = 7 ng/mL
C. Normal growth rate
D. Normal insulin-like growth factor 1 levels
E. Normal parental height

EXPLN! !!!
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  #2  
Old 07-10-2012
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ans ; d i guess ...
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Old 07-10-2012
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E? If the pt's parent has normal height then famiolal short stature is less likely
not A = constitutional has delayed bone age than chronological age.
not B, C, D = familial short stature's growth aspects are normal....although NORMALLY short genetically.
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Old 07-10-2012
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normal growth velocity.

in contitutional delay the growth velocity is normal by definition.

there is a delay however in the growth spurt.. which when happens.. results in catch up growth.


abnormal growth velocity is highly indicative of genetic syndromes.




other options --
related to Growth HOrmone/IGF ---- do rule out short stature as a result of lack of GH. but donot rule out the other acquired causes such as hypothyroid/ chronic illness/ nutrn deffn etc.


normal parental height -- rules out familial short stature. but doesnt rule IN constitutional delay


Bone age and chronological age -- not height

BA<CA = constitutional delay
BA=CA ==== familial short stature
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Old 07-10-2012
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Default E

Out of those choices, I would choose E, since it's the only one that is not a normal value in the patient.

edit: totally agree with mbbs2010, though, that one couldn't just assume CGD (a variant of normal growth), so we'd have to rule out pathological causes for the short stature (chromosomal, nutritional, endocrine, etc...)

Last edited by Mondoshawan; 07-10-2012 at 05:14 PM.
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Old 07-11-2012
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with due respects to this **** qbank ans mentioned is
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[COLOR="Red"]Option A [/COLOR](Bone age consistent with height age) is correct. Bone age, or skeletal maturation, is equal to the chronologic age in genetic short stature but is less than chronologic age in constitutional delay. Bone age is consistent with height age in constitutional delay.

Option B (Growth hormone level = 7 ng/mL) is incorrect. Growth hormone levels are normal in both conditions and are useless in distinguishing one from the other.

Option C (Normal growth rate) is incorrect. Growth rate is not useful in differentiating between the two because it is normal in both conditions, usually 4.5 to 5 cm per year.

Option D (Normal insulin-like growth factor 1 levels) is incorrect. Insulin-like growth factor 1 levels reflect those of growth hormone and may be used to diagnose growth hormone deficiency, but are useless in differentiating between genetic short stature and constitutional delay.

Option E (Normal parental height) is incorrect. Parental height cannot help in differentiating the two conditions because height is usually normal in both.
can any1 make sense why A is ans. or ans A is incorrect?
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Old 07-11-2012
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Quote:
Originally Posted by tyagee View Post
can any1 make sense why A is ans. or ans A is incorrect?
It's quite simple. Bone age and height means same thing, how can you grow in height without growth in bone?
As mbbs 2010 has pointed out that Constitutional growth delay has decreased Bone age in relation to chronological age.

Quote:
Bone age and chronological age -- not height

BA<CA = constitutional delay
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