Growth Hormone Deficiency

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Introduction

Decreased growth hormone is trouble

 

 

 

The Case of...

a simple case introducing clincial presentation and calling for a differential diagnosis. To get students thinking.

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Causes and Risk Factors

Congenital GH deficiency can be:

Acquired GH deficiency:

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Pathophysiology

GH is important for chondrocyte proliferation and IGF-1 release. GH has little impact on fetal growth, as maternal and placental factors are more important.

IGF-1 acts on the liver and long bones.

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Signs and Symptoms

  • history
  • physical exam

History

Impaired QoL

  • Increased WHR and total body fat
  • impaired cardiac function and muscle mass
  • decreased fibrinolytic activity
  • increased cholesterol
  • abdominal obesity
  • insulin resistance

high-pitched voice

 

Physical Exam

Short, chubby infants

delayed puberty

  • boys can have micropenis and undescended testes

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Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

hypoglycemia

GH stimulation testing if strong indication

  • give arginine, insulin, dopamine, or propanolol
  • +ve test if GH does not sufficiently rise

Diagnostic Imaging

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Differential Diagnosis

Other causes of short stature should be strongly considered, as true GH deficiency is quite rare.

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Treatments

GH replacement if GH is proven to be deficient, if epiphyses are unfused, and...

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Consequences and Course

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Additional Resources

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Topic Development

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