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Short stature 2017

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  1. 1. Approach to short stature Dr.Yassin M Al-Saleh
  2. 2. Their Prophet said to them: 'Allah has raised Saul to be your king. ' But they replied: 'Should he be given the kingship over us, when we are more deserving of it than he and he has not been given abundant wealth? ' He said: 'Allah has chosen him over you and increased him with amplitude in knowledge and body. Allah gives His kingship to whom He will. Allah is the
  3. 3. Case scenario 5y8m old boy brought by parent with concern regarding the growth.
  4. 4. Case scenario cont. Not growing well since birth. Systemic review: Chronic constipation since birth. Pallor. Anorexia. Wearing glasses.
  5. 5. Case scenario cont. Perinatal: FT,NSVD, BW: normal Uneventful pregnancy. Past medical : Chronic constipation since birth mostly functional. Past surgical: Rectal biopsy twice. Inconclusive. Medication: Was on lactlose and enema no more.
  6. 6. Case scenario cont. Allergy: none. Diet: poor appitite , anorexic most of the time. Development: excellent in KG. Family history: consangous marriage . 4 other brothers all tall. No family history of short relative or constiotional. Social: unremarkable
  7. 7. Case scenario cont. Exam: Soft dysmorphism . no disproportion. Vital sign: stable Weight on third. HT 3 SD below the mean HC normal MPH172. upper to lower segment : 1.2 Arm span -2 Height velocity 3cm per year pubertal status. Tanner 1 Nutritional status cachectic Systemic exam: head-to-toe fair color, wearing glasses. CVS,CHEST,ABDOMIN,neuro, thyroid, musculoskeletal.
  8. 8. DDx: Systemic diseases: Gastrointestinal Malapsorption ,celiac cystic fibrosis renal disease renal tubular acidosis chronic renal insufficiency Hematological: Anamia. Endocrinopathies: Hypothyrodism. GHD. ISS.
  9. 9. INTRODUCTION Definition of short stature: length or height more than 2 (SD) below the mean (13-14 years in girls >15-16 years in boys. when to stop
  10. 35. complications increased intracranial pressure. SCFE. Impaired GTT. joint pain, muscle pain. carpal tunnel syndrome. Pancreatitis. Scoliosis. Increased risk of recurrence of neoplasim.
  11. 36. Any new treatment?? insulin-like growth factor (IGF). GnRH analoug. Aromates inhibitor. Testosterone.
  12. 37. Appendages
  13. 38. History 1958: Maurice Raben purified GH from cadaver pituitary glands; treated patient who had GH deficiency.
  14. 39. History 1981: Boyer and Swanson use recombinant DNA technology to synthesize GH the first such use of this technology. 1985: Four cases of Creutzfeldt-Jakob disease in recipients of cadaver-derived GH 1985: FDA approves recombinant DNA-derived human GH for children with GH-deficiency
  15. 40. Gallery
  16. 41. Turner syndrome
  17. 42. prader-willi syndrome
  18. 43. russell silver syndrome
  19. 44. Seckel syndrome
  20. 45. achondroplasia