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{{Growth hormone deficiency}}
{{Growth hormone deficiency}}
{{CMG}}
{{CMG}}; {{AE}} {{MAD}}


==Overview==
==Overview==
Patients with growth hormone deficiency usually look tired and less energetic than normal subjects.  Extremities show [[Clubbing]], [[muscle atrophy]], [[neonatal jaundice]], [[Cyanosis|neonatal cyanosis]]. Head may show infantile facies, [[Dentition|delayed dentition]], and brittle hair. Children may show [[hyporeflexia]] and [[delayed puberty]].
==Physical Examination==
==Physical Examination==
===Appearance===
In children,
* Proportional stature well below that expected for family heights
* Below-normal velocity of growth
* Delayed physical maturation
*Mild to moderate chubbiness
*Cherubic facial features characterized by [[maxilla]]ry hypoplasia and forehead prominence (said to resemble a kewpie doll).                                                                                                                                                                                                                                                                                       


===Neurologic Examination===
===Appearance of the Patient===
In adults,
*Children with growth hormone deficiency usually look tired and less energetic than normal subjects of the same age with infantile doll-like body shape. 
* Diminished muscle strength
*In adults, increased lean [[body mass]] causes [[weight gain]], especially around the [[waist]].<ref name="pmid25070016">{{cite journal| author=Fukuda I, Hizuka N, Muraoka T, Ichihara A| title=Adult growth hormone deficiency: current concepts. | journal=Neurol Med Chir (Tokyo) | year= 2014 | volume= 54 | issue= 8 | pages= 599-605 | pmid=25070016 | doi= | pmc=4533495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25070016  }}</ref>
 
=== Back ===
* [[Osteoporosis]] and tenderness of the [[Lumbar spine|lumbar spine]] are higher in patients compared with normal subjects.<ref name="pmid22157400">{{cite journal| author=Stanley T| title=Diagnosis of growth hormone deficiency in childhood. | journal=Curr Opin Endocrinol Diabetes Obes | year= 2012 | volume= 19 | issue= 1 | pages= 47-52 | pmid=22157400 | doi=10.1097/MED.0b013e32834ec952 | pmc=3279941 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22157400  }}</ref>
 
===Vital Signs===
 
*[[Hypothermia]] associated with [[hypothyroidism]]


===Genitourinary system===
===Skin===
*[[Micropenis]]
*[[Cyanosis]] in neonates
*[[Jaundice]] in neonates


When these features are accompanied by corroboratory evidence of [[hypopituitarism]] such as deficiency of other pituitary hormones, a structurally abnormal pituitary, or a history of damage to the pituitary, the diagnosis is confirmed and presumed to be lifelong. When these corroborative features are not present, further testing is needed to establish the diagnosis.
===HEENT===
* Infantile facies
* Delayed [[Dentition|dentition]]
* Brittle hair.
 
===Neck===
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally due to the high rate of [[atherosclerosis]].<ref name="pmid26550626" />
 
===Abdomen===
*[[Abdominal distention]] 
 
===Genitourinary===
*[[Cryptorchidism]] and [[micropenis]] in infants<ref name="pmid27974187" />
*[[Delayed puberty]] in children<ref name="pmid26550626">{{cite journal| author=Nielsen J, Jensen RB, Afdeling AJ| title=[Growth hormone deficiency in children]. | journal=Ugeskr Laeger | year= 2015 | volume= 177 | issue= 26 | pages= 1260-3 | pmid=26550626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26550626  }}</ref>
 
===Neuromuscular===
* [[Hyporeflexia]]
* [[Muscle weakness]] bilaterally
 
===Extremities===
*[[Clubbing]]
*[[Cyanosis]] [[Cyanosis|in neonates]]
*[[Jaundice]] in neonates
*Pitting/non-pitting [[edema]]
*[[Muscle atrophy]]<ref name="pmid27974187">{{cite journal| author=Chinoy A, Murray PG| title=Diagnosis of growth hormone deficiency in the paediatric and transitional age. | journal=Best Pract Res Clin Endocrinol Metab | year= 2016 | volume= 30 | issue= 6 | pages= 737-747 | pmid=27974187 | doi=10.1016/j.beem.2016.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27974187  }}</ref>


==References==
==References==
{{Reflist|2}}
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[[Category:Disease]]
[[Category:Endocrinology]]

Latest revision as of 20:21, 26 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Overview

Patients with growth hormone deficiency usually look tired and less energetic than normal subjects. Extremities show Clubbing, muscle atrophy, neonatal jaundice, neonatal cyanosis. Head may show infantile facies, delayed dentition, and brittle hair. Children may show hyporeflexia and delayed puberty.

Physical Examination

Appearance of the Patient

  • Children with growth hormone deficiency usually look tired and less energetic than normal subjects of the same age with infantile doll-like body shape.
  • In adults, increased lean body mass causes weight gain, especially around the waist.[1]

Back

Vital Signs

Skin

HEENT

  • Infantile facies
  • Delayed dentition
  • Brittle hair.

Neck

Abdomen

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ Fukuda I, Hizuka N, Muraoka T, Ichihara A (2014). "Adult growth hormone deficiency: current concepts". Neurol Med Chir (Tokyo). 54 (8): 599–605. PMC 4533495. PMID 25070016.
  2. ↑ Stanley T (2012). "Diagnosis of growth hormone deficiency in childhood". Curr Opin Endocrinol Diabetes Obes. 19 (1): 47–52. doi:10.1097/MED.0b013e32834ec952. PMC 3279941. PMID 22157400.
  3. ↑ 3.0 3.1 Nielsen J, Jensen RB, Afdeling AJ (2015). "[Growth hormone deficiency in children]". Ugeskr Laeger. 177 (26): 1260–3. PMID 26550626.
  4. ↑ 4.0 4.1 Chinoy A, Murray PG (2016). "Diagnosis of growth hormone deficiency in the paediatric and transitional age". Best Pract Res Clin Endocrinol Metab. 30 (6): 737–747. doi:10.1016/j.beem.2016.11.002. PMID 27974187.

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