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. Case scenario 5y8m old boy brought by parent with concern
regarding the growth.
4. Case scenario cont. Not growing well since birth. Systemic
review: Chronic constipation since birth. Pallor. Anorexia. Wearing
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. 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:
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.
36. Any new treatment?? insulin-like growth factor (IGF). GnRH
analoug. Aromates inhibitor. Testosterone.
38. History 1958: Maurice Raben purified GH from cadaver
pituitary glands; treated patient who had GH deficiency.
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