Growth hormone deficiency differential diagnosis: Difference between revisions

Latest revision as of 18:24, 25 February 2019

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

Overview

Growth hormone deficiency in children must be differentiated from other diseases that cause short stature such as: Achondroplasia, constitutional growth delay, familial short stature, growth hormone resistance, Noonan Syndrome, Panhypopituitarism, pediatric hypothyroidism, short stature accompanying systemic disease, psychosocial short stature, Silver-Russell Syndrome, Turner Syndrome, and idiopathic short stature.

Differentiating Growth Hormone Deficiency from other Diseases

Growth hormone deficiency in children must be differentiated from other diseases that cause short stature. Short stature is defined as the height that is 2 standard deviations(SD) or more below the mean height for children of that sex and chronological age in a given population.^[1] Theses causes include:

Achondroplasia
Constitutional growth delay
Familial short stature
Growth hormone resistance
Noonan syndrome
Panhypopituitarism
Pediatric hypothyroidism
Short stature accompanying systemic disease
Psychosocial short stature
Silver-Russell syndrome
Turner syndrome
Idiopathic short stature

Diseases	History and symptoms	Puberty development	Height velocity	Parents height	Characteristic facies	Bone age	Genetic analysis	GH level
Diseases	History and symptoms	Physical Examination				Laboratory findings
Growth hormone deficiency^[2]	Children: delayed developmental milestones and muscle weakness Adults: increased lean body mass, osteopenia, and dyslipidemia	Delayed	Decreased	Normal	Doll-like fat distribution pattern Immature face with under developed nasal bridge Infantile voice	Delayed	POU1F1 gene mutations GH1 gene mutations	Low
Achondroplasia^[3]	Normal Intelligence quotient A trunk of average size Arms and legs of diminished length Spinal stenosis Kyphosis and lordosis	Normal	Decreased	Decreased	Large heads Prominent forehead Midface hypoplasia	Delayed	FGFR3 gene mutations	Normal
Familial short stature^[4]	A normal variant with normal signs, investigations. Positive family history	Normal	Decreased	Decreased	Normal	Normal	Heterozygous IGF1 Splicing mutation	Normal
Constitutional growth delay^[5]	Family history of delayed growth spurt and puberty Childhood short stature but relatively normal adult height Normal size at birth A delayed growth rate begins at three to six months of age A family history of delayed growth and puberty in one or both parents	Delayed .	Normal	Normal	Normal	Normal	Mutations in Variation in FGFR1, GNRHR, TAC3, and TACR3 genes	Normal
Growth Hormone Resistance^[6]	Growth hormone insensitivity is an absence of the biological effects of growth hormone despite a normal production of GH. Its severity correlates to IGF-I and insulin-like growth factor-binding protein 3 (IGFBP-3) levels.	Delayed	Decreased	Normal	Small face in relation to head circumference Delayed dentition	Delayed	Growth hormone receptor mutations IGF-I gene mutations	Normal
Pediatric hypothyroidism^[7]	Low muscle tone Cold intolerance Persistent constipation Fatigue and weaknessExcessive sleeping Exaggerated jaundice	Delayed	Decreased	Normal	Puffy face Macroglossia Large fontanels Micrognathia	Delayed	Mutations in: Paired box 8 (PAX8) Thyroid Transcription factor-2 (TTF2) Transcription factors NK2	Normal
Turner syndrome^[8]	Females only Infertility Webbed neck Widely spaced nipples Broad chest Genu valgum Short neck Ovarian failure	Absent	Decreased	Decreased	Low hairline Low-set ears Characteristic facial features	Normal	45 X0	Normal
Silver-Russell Syndrome^[9]	Hemihypertrophy Hypoglycemia Wide fontanelle Clinodactyly Precocious puberty	Delayed	Decreased	Decreased	Prominent forehead Triangular face Downturned corners of the mouth Small jaw Pointed chin	Normal	Methylation involving the H19 and IGF2 genes	Normal
Noonan syndrome^[10]	Bleeding tendency Webbed neck Cryptorchidism Intellectual disability	Delayed	Decreased	Decreased	Minor facial dysmorphism	Normal	PTPN11 and SOS1 genes abnormality	Normal
Psychosocial short stature^[11]	A disorder of short stature or growth that is observed in association with emotional deprivation A disturbed relationship between child and caregiver is usually noted. A history of abuse or neglect and emotional deprivation The relationship between the caregiver and the child appears to be abnormal.	Delayed	Decreased	Normal	Failure to thrive Poor dental hygiene Sad Affect	Normal	Normal	Maybe low
Short stature accompanying systemic disease^[12]	Growth failure is seen in children with systemic diseases such as chronic kidney disease, malignancy, Chron's disease, and Cushing disease. The primary causes of growth failure in children include metabolic acidosis, poor nutrition secondary to dietary restrictions, disturbances of growth hormone metabolism and its main mediator, insulin-like growth factor-I (IGF-I).	Delayed	Decreased	Normal	Failure to thrive	Delayed	Normal	Normal
Idiopathic short stature^[13]	A height below 2 standard deviations (SD) of the mean for age, in the absence of any endocrine, metabolic, or other diagnosis	Normal	Decreased	Normal	Normal	Delayed	SHOX gene mutations^[14]	Normal

References

↑ Yadav S, Dabas A (2015). "Approach to short stature". Indian J Pediatr. 82 (5): 462–70. doi:10.1007/s12098-014-1609-y. PMID 25465677.
↑ Colao A, Di Somma C, Pivonello R, Loche S, Aimaretti G, Cerbone G; et al. (1999). "Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism". J Clin Endocrinol Metab. 84 (6): 1919–24. doi:10.1210/jcem.84.6.5742. PMID 10372687.
↑ Bouali H, Latrech H (2015). "Achondroplasia: Current Options and Future Perspective". Pediatr Endocrinol Rev. 12 (4): 388–95. PMID 26182483.
↑ Kawashima Y, Hakuno F, Okada S, Hotsubo T, Kinoshita T, Fujimoto M; et al. (2014). "Familial short stature is associated with a novel dominant-negative heterozygous insulin-like growth factor 1 receptor (IGF1R) mutation". Clin Endocrinol (Oxf). 81 (2): 312–4. doi:10.1111/cen.12317. PMID 24033502.
↑ Vaaralahti K, Wehkalampi K, Tommiska J, Laitinen EM, Dunkel L, Raivio T (2011). "The role of gene defects underlying isolated hypogonadotropic hypogonadism in patients with constitutional delay of growth and puberty". Fertil Steril. 95 (8): 2756–8. doi:10.1016/j.fertnstert.2010.12.059. PMID 21292259.
↑ Kurtoğlu S, Hatipoglu N (2016). "Growth hormone insensitivity: diagnostic and therapeutic approaches". J Endocrinol Invest. 39 (1): 19–28. doi:10.1007/s40618-015-0327-2. PMID 26062520.
↑ Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G; et al. (2014). "European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism". Horm Res Paediatr. 81 (2): 80–103. doi:10.1159/000358198. PMID 24662106.
↑ Trovó de Marqui AB (2015). "[Turner syndrome and genetic polymorphism: a systematic review]". Rev Paul Pediatr. 33 (3): 364–71. doi:10.1016/j.rpped.2014.11.014. PMC 4620965. PMID 25765448.
↑ Wakeling EL (2011). "Silver-Russell syndrome". Arch Dis Child. 96 (12): 1156–61. doi:10.1136/adc.2010.190165. PMID 21349887.
↑ Razzaque MA, Nishizawa T, Komoike Y, Yagi H, Furutani M, Amo R; et al. (2007). "Germline gain-of-function mutations in RAF1 cause Noonan syndrome". Nat Genet. 39 (8): 1013–7. doi:10.1038/ng2078. PMID 17603482.
↑ Sandberg DE, Gardner M (2015). "Short Stature: Is It a Psychosocial Problem and Does Changing Height Matter?". Pediatr Clin North Am. 62 (4): 963–82. doi:10.1016/j.pcl.2015.04.009. PMID 26210627.
↑ Sanderson IR (2014). "Growth problems in children with IBD". Nat Rev Gastroenterol Hepatol. 11 (10): 601–10. doi:10.1038/nrgastro.2014.102. PMID 24957008.
↑ Wit JM, Clayton PE, Rogol AD, Savage MO, Saenger PH, Cohen P (2008). "Idiopathic short stature: definition, epidemiology, and diagnostic evaluation". Growth Horm IGF Res. 18 (2): 89–110. doi:10.1016/j.ghir.2007.11.004. PMID 18182313.
↑ Ouni M, Castell AL, Rothenbuhler A, Linglart A, Bougnères P (2015). "Higher methylation of the IGF1 P2 promoter is associated with idiopathic short stature". Clin Endocrinol (Oxf). doi:10.1111/cen.12867. PMID 26218795.

Template:WH Template:WS

[pmid25465677-1] Yadav S, Dabas A (2015). "Approach to short stature". Indian J Pediatr. 82 (5): 462–70. doi:10.1007/s12098-014-1609-y. PMID 25465677.

[pmid10372687-2] Colao A, Di Somma C, Pivonello R, Loche S, Aimaretti G, Cerbone G; et al. (1999). "Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism". J Clin Endocrinol Metab. 84 (6): 1919–24. doi:10.1210/jcem.84.6.5742. PMID 10372687.

[pmid26182483-3] Bouali H, Latrech H (2015). "Achondroplasia: Current Options and Future Perspective". Pediatr Endocrinol Rev. 12 (4): 388–95. PMID 26182483.

[pmid24033502-4] Kawashima Y, Hakuno F, Okada S, Hotsubo T, Kinoshita T, Fujimoto M; et al. (2014). "Familial short stature is associated with a novel dominant-negative heterozygous insulin-like growth factor 1 receptor (IGF1R) mutation". Clin Endocrinol (Oxf). 81 (2): 312–4. doi:10.1111/cen.12317. PMID 24033502.

[pmid21292259-5] Vaaralahti K, Wehkalampi K, Tommiska J, Laitinen EM, Dunkel L, Raivio T (2011). "The role of gene defects underlying isolated hypogonadotropic hypogonadism in patients with constitutional delay of growth and puberty". Fertil Steril. 95 (8): 2756–8. doi:10.1016/j.fertnstert.2010.12.059. PMID 21292259.

[pmid26062520-6] Kurtoğlu S, Hatipoglu N (2016). "Growth hormone insensitivity: diagnostic and therapeutic approaches". J Endocrinol Invest. 39 (1): 19–28. doi:10.1007/s40618-015-0327-2. PMID 26062520.

[pmid24662106-7] Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G; et al. (2014). "European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism". Horm Res Paediatr. 81 (2): 80–103. doi:10.1159/000358198. PMID 24662106.

[pmid25765448-8] Trovó de Marqui AB (2015). "[Turner syndrome and genetic polymorphism: a systematic review]". Rev Paul Pediatr. 33 (3): 364–71. doi:10.1016/j.rpped.2014.11.014. PMC 4620965. PMID 25765448.

[pmid21349887-9] Wakeling EL (2011). "Silver-Russell syndrome". Arch Dis Child. 96 (12): 1156–61. doi:10.1136/adc.2010.190165. PMID 21349887.

[pmid17603482-10] Razzaque MA, Nishizawa T, Komoike Y, Yagi H, Furutani M, Amo R; et al. (2007). "Germline gain-of-function mutations in RAF1 cause Noonan syndrome". Nat Genet. 39 (8): 1013–7. doi:10.1038/ng2078. PMID 17603482.

[pmid26210627-11] Sandberg DE, Gardner M (2015). "Short Stature: Is It a Psychosocial Problem and Does Changing Height Matter?". Pediatr Clin North Am. 62 (4): 963–82. doi:10.1016/j.pcl.2015.04.009. PMID 26210627.

[pmid24957008-12] Sanderson IR (2014). "Growth problems in children with IBD". Nat Rev Gastroenterol Hepatol. 11 (10): 601–10. doi:10.1038/nrgastro.2014.102. PMID 24957008.

[pmid18182313-13] Wit JM, Clayton PE, Rogol AD, Savage MO, Saenger PH, Cohen P (2008). "Idiopathic short stature: definition, epidemiology, and diagnostic evaluation". Growth Horm IGF Res. 18 (2): 89–110. doi:10.1016/j.ghir.2007.11.004. PMID 18182313.

[pmid26218795-14] Ouni M, Castell AL, Rothenbuhler A, Linglart A, Bougnères P (2015). "Higher methylation of the IGF1 P2 promoter is associated with idiopathic short stature". Clin Endocrinol (Oxf). doi:10.1111/cen.12867. PMID 26218795.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Growth hormone deficiency}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Growth_hormone_deficiency]]
 {{CMG}}; {{AE}} {{MAD}}
 ==Overview==
+Growth hormone deficiency in children must be differentiated from other diseases that cause [[short stature]] such as: [[Achondroplasia]], [[Constitutional growth delay|constitutional growth delay,]] [[Short stature|familial short stature]], growth hormone resistance, [[Noonan syndrome|Noonan Syndrome]], [[Panhypopituitarism]], [[Hypothyroidism|pediatric hypothyroidism]], short stature accompanying systemic disease, psychosocial short stature, [[Silver-Russell Syndrome|Silver-Russell Syndrome,]] [[Turner syndrome|Turner Syndrome]], and [[idiopathic short stature]].
 ==Differentiating Growth Hormone Deficiency from other Diseases==
-Growth hormone deficiency in children must be differentiated from other diseases that cause short stature in children such as:
+Growth hormone deficiency in children must be differentiated from other diseases that cause [[short stature]]. [[Short stature]] is defined as the height that is 2 [[Standard deviation|standard deviations]](SD) or more below the [[mean]] height for children of that sex and chronological age in a given population.<ref name="pmid25465677">{{cite journal| author=Yadav S, Dabas A| title=Approach to short stature. | journal=Indian J Pediatr | year= 2015 | volume= 82 | issue= 5 | pages= 462-70 | pmid=25465677 | doi=10.1007/s12098-014-1609-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25465677  }}</ref> Theses causes include:
 * [[Achondroplasia]]
-* Constitutional Growth Delay
+* [[Constitutional growth delay]]
 * Familial short stature
-* Growth Hormone Resistance
+* [[Laron syndrome|Growth hormone resistance]]
-* [[Noonan syndrome|Noonan Syndrome]]
+* [[Noonan syndrome|Noonan syndrome]]
 * [[Panhypopituitarism]]
-* [[Hypothyroidism|Pediatric Hypothyroidism]]
+* [[Hypothyroidism|Pediatric hypothyroidism]]
-* [[Short stature]] accompanying systemic disease
+* Short stature accompanying systemic disease
-* Short stature from [[Child Abuse|abuse]] and neglect
+* Psychosocial short stature
-* [[Silver-Russell Syndrome]]
+* [[Silver-Russell Syndrome|Silver-Russell syndrome]]
-* [[Turner syndrome|Turner Syndrome]]
+* [[Turner syndrome|Turner syndrome]]
+* [[Idiopathic short stature]]
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
@@ Line 32: / Line 35: @@
 !GH level
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Growth hormone deficiency
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Growth hormone deficiency<ref name="pmid10372687">{{cite journal| author=Colao A, Di Somma C, Pivonello R, Loche S, Aimaretti G, Cerbone G et al.| title=Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism. | journal=J Clin Endocrinol Metab | year= 1999 | volume= 84 | issue= 6 | pages= 1919-24 | pmid=10372687 | doi=10.1210/jcem.84.6.5742 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10372687  }}</ref>
 | style="background: #F5F5F5; padding: 5px;" |
 * Children: delayed [[developmental milestones]] and [[muscle weakness]]
@@ Line 41: / Line 44: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * Doll-like fat distribution pattern
-* Immature face with under developed nasal bridge
+* Immature face with under developed [[nasal bridge]]
 * Infantile voice
-| style="background: #F5F5F5; padding: 5px;" |Dlayed
+| style="background: #F5F5F5; padding: 5px;" |Delayed
 | style="background: #F5F5F5; padding: 5px;" |
-* ''POU1F1'' gene mutations
+* ''POU1F1'' [[Gene mutation|gene mutations]]
-* GH1 gene mutations
+* GH1 [[Gene mutation|gene mutations]]
 | style="background: #F5F5F5; padding: 5px;" |Low
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Achondroplasia]]
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Achondroplasia]]<ref name="pmid26182483">{{cite journal| author=Bouali H, Latrech H| title=Achondroplasia: Current Options and Future Perspective. | journal=Pediatr Endocrinol Rev | year= 2015 | volume= 12 | issue= 4 | pages= 388-95 | pmid=26182483 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26182483  }}</ref>
 | style="background: #F5F5F5; padding: 5px;" |
 * Normal [[Intelligence test|Intelligence quotient]]
@@ Line 65: / Line 68: @@
 | style="background: #F5F5F5; padding: 5px;" |Delayed
 | style="background: #F5F5F5; padding: 5px;" |
-FGFR3 gene mutations
+[[FGFR3 gene|FGFR3]] gene mutations
 | style="background: #F5F5F5; padding: 5px;" |Normal
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Familial short stature
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Familial short stature<ref name="pmid24033502">{{cite journal| author=Kawashima Y, Hakuno F, Okada S, Hotsubo T, Kinoshita T, Fujimoto M et al.| title=Familial short stature is associated with a novel dominant-negative heterozygous insulin-like growth factor 1 receptor (IGF1R) mutation. | journal=Clin Endocrinol (Oxf) | year= 2014 | volume= 81 | issue= 2 | pages= 312-4 | pmid=24033502 | doi=10.1111/cen.12317 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24033502  }}</ref>
 | style="background: #F5F5F5; padding: 5px;" |
 * A normal variant with normal signs, investigations.
@@ Line 77: / Line 80: @@
 | style="background: #F5F5F5; padding: 5px;" |Normal
 | style="background: #F5F5F5; padding: 5px;" |Normal
-| style="background: #F5F5F5; padding: 5px;" |Normal
+| style="background: #F5F5F5; padding: 5px;" |[[Heterozygous]] ''[[IGF1]]'' [[Splicing]] [[mutation]]
 | style="background: #F5F5F5; padding: 5px;" |Normal
 |-
-|Constitutional growth delay
+|Constitutional growth delay<ref name="pmid21292259">{{cite journal| author=Vaaralahti K, Wehkalampi K, Tommiska J, Laitinen EM, Dunkel L, Raivio T| title=The role of gene defects underlying isolated hypogonadotropic hypogonadism in patients with constitutional delay of growth and puberty. | journal=Fertil Steril | year= 2011 | volume= 95 | issue= 8 | pages= 2756-8 | pmid=21292259 | doi=10.1016/j.fertnstert.2010.12.059 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292259  }}</ref>
 |
-* Family history of delayed growth and puberty
+* Family history of [[Delayed growth;|delayed growth]] spurt and [[puberty]]
-* Childhood short stature but relatively normal adult height.
+* Childhood short stature but relatively normal adult height
 * Normal size at birth
 * A delayed growth rate begins at three to six months of age
@@ Line 95: / Line 98: @@
 |Normal
 |Normal
-|Normal
+|Mutations in Variation in ''[[FGFR1]]'', ''[[GNRHR]], [[TAC 3|TAC3]],'' and ''TACR3 genes''
 |Normal
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Growth Hormone Resistance
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Growth Hormone Resistance<ref name="pmid26062520">{{cite journal| author=Kurtoğlu S, Hatipoglu N| title=Growth hormone insensitivity: diagnostic and therapeutic approaches. | journal=J Endocrinol Invest | year= 2016 | volume= 39 | issue= 1 | pages= 19-28 | pmid=26062520 | doi=10.1007/s40618-015-0327-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26062520  }}</ref>
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Growth hormone insensitivity syndrome|Growth hormone insensitivity]] is an absence of the biological effects of growth hormone despite a normal production of [[Growth hormone|GH]].
@@ Line 111: / Line 114: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Growth hormone receptor]] mutations
-* [[Insulin-like growth factor-I|IGF-I]] gene mutations
+* [[Insulin-like growth factor-I|IGF-I]] [[Gene mutation|gene mutations]]
 | style="background: #F5F5F5; padding: 5px;" |Normal
 |-
-|[[Hypothyroidism|Pediatric Hypothyroidism]]
+|[[Hypothyroidism|Pediatric hypothyroidism]]<ref name="pmid24662106">{{cite journal| author=Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G et al.| title=European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. | journal=Horm Res Paediatr | year= 2014 | volume= 81 | issue= 2 | pages= 80-103 | pmid=24662106 | doi=10.1159/000358198 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24662106  }}</ref>
 |
 * Low [[muscle tone]]
@@ Line 125: / Line 128: @@
 |Normal
 |
-* Puffy facies
+* Puffy face
 * [[Macroglossia]]
@@ Line 135: / Line 138: @@
 * Paired box 8 [[PAX8 gene|(''PAX8)'']]
-* Thyroid Transcription factor-2 (''TTF2''
+* Thyroid Transcription factor-2 (''TTF2)''
 * Transcription factors NK2
 |Normal
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Turner syndrome|Turner Syndrome]]
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Turner syndrome|Turner syndrome]]<ref name="pmid25765448">{{cite journal| author=Trovó de Marqui AB| title=[Turner syndrome and genetic polymorphism: a systematic review]. | journal=Rev Paul Pediatr | year= 2015 | volume= 33 | issue= 3 | pages= 364-71 | pmid=25765448 | doi=10.1016/j.rpped.2014.11.014 | pmc=4620965 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25765448  }}</ref>
 | style="background: #F5F5F5; padding: 5px;" |
 * Females only
@@ Line 160: / Line 163: @@
 | style="background: #F5F5F5; padding: 5px;" |Normal
 |-
-|[[Silver-Russell Syndrome]]
+|[[Silver-Russell Syndrome]]<ref name="pmid21349887">{{cite journal| author=Wakeling EL| title=Silver-Russell syndrome. | journal=Arch Dis Child | year= 2011 | volume= 96 | issue= 12 | pages= 1156-61 | pmid=21349887 | doi=10.1136/adc.2010.190165 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21349887  }}</ref>
 |
 * [[Hemihypertrophy]]
@@ Line 181: / Line 184: @@
 |Normal
 |-
-|[[Noonan syndrome|Noonan Syndrome]]
+|[[Noonan syndrome|Noonan syndrome]]<ref name="pmid17603482">{{cite journal| author=Razzaque MA, Nishizawa T, Komoike Y, Yagi H, Furutani M, Amo R et al.| title=Germline gain-of-function mutations in RAF1 cause Noonan syndrome. | journal=Nat Genet | year= 2007 | volume= 39 | issue= 8 | pages= 1013-7 | pmid=17603482 | doi=10.1038/ng2078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17603482  }}</ref>
 |
 * [[Bleeding tendency]]
@@ Line 197: / Line 200: @@
 |Normal
 |-
-|Psychosocial Short Stature
+|Psychosocial short stature<ref name="pmid26210627">{{cite journal| author=Sandberg DE, Gardner M| title=Short Stature: Is It a Psychosocial Problem and Does Changing Height Matter? | journal=Pediatr Clin North Am | year= 2015 | volume= 62 | issue= 4 | pages= 963-82 | pmid=26210627 | doi=10.1016/j.pcl.2015.04.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26210627  }}</ref>
-|
-|
-|
 |
+* A disorder of [[short stature]] or growth that is observed in association with emotional deprivation
+* A disturbed relationship between child and caregiver is usually noted.
+* A history of [[abuse]] or neglect and emotional deprivation
+* The relationship between the caregiver and the child appears to be abnormal.
+|Delayed
+|Decreased
+|Normal
 |
 * [[Failure to thrive]]
-* [[Poor dental hygiene|Poor dental hyegine]]
+* [[Poor dental hygiene|Poor dental hygiene]]
 * Sad Affect
 |Normal
-|No puberty
+|Normal
-|
+|Maybe low
 |-
-|Short stature accompanying systemic disease
+|Short stature accompanying systemic disease<ref name="pmid24957008">{{cite journal| author=Sanderson IR| title=Growth problems in children with IBD. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 10 | pages= 601-10 | pmid=24957008 | doi=10.1038/nrgastro.2014.102 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24957008  }}</ref>
 |
-* Growth failure is seen in children with systemic diseases such as chronic kidney disease.
+* [[Growth failure]] is seen in children with systemic diseases such as [[chronic kidney disease]], [[malignancy]], [[Crohn's disease|Chron's disease,]] and [[Cushing's Disease|Cushing disease]].
-* The primary causes of growth failure in children include metabolic acidosis, poor nutrition secondary to dietary restrictions. disturbances of growth hormone metabolism and its main mediator, insulin-like growth factor-I (IGF-I).
+* The primary causes of growth failure in children include [[metabolic acidosis]], poor nutrition secondary to dietary restrictions,  disturbances of growth hormone metabolism and its main mediator, [[insulin-like growth factor-I]] ([[Insulin-like growth factor-I|IGF-I)]].
-* Other factors may
-* Screening lab tests of the systemic disease is abnormal , for example, BUN, creatinine,
-* and urine analysis in chronic kidney disease.
 |Delayed
 |Decreased
 |Normal
-|Failure to thrive
+|[[Failure to thrive]]
 |Delayed
 |Normal
 |Normal
 |-
-|[[Idiopathic short stature]]
+|[[Idiopathic short stature]]<ref name="pmid18182313">{{cite journal| author=Wit JM, Clayton PE, Rogol AD, Savage MO, Saenger PH, Cohen P| title=Idiopathic short stature: definition, epidemiology, and diagnostic evaluation. | journal=Growth Horm IGF Res | year= 2008 | volume= 18 | issue= 2 | pages= 89-110 | pmid=18182313 | doi=10.1016/j.ghir.2007.11.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18182313  }}</ref>
-|A height below 2 standard deviations (SD) of the mean for age, in the absence of any endocrine, metabolic, or other diagnosis
+|A height below 2 [[Standard deviation|standard deviations]] (SD) of the mean for age, in the absence of any endocrine, metabolic, or other diagnosis
 |Normal
 |Decreased

Growth hormone deficiency differential diagnosis: Difference between revisions

Latest revision as of 18:24, 25 February 2019

Overview

Differentiating Growth Hormone Deficiency from other Diseases

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