HISTORY TAKING IN PEDIATRIC ENDOCRINE DISEASE

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HISTORY TAKING IN PEDIATRIC ENDOCRINE DISEASE
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DEFINITION
SHORT STATURE

• The term short stature describes height that is
  in the third percentile as compared to the
  average height for a persons age, sex, and
  racial group

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Causes

• Normal variants
• Non-endocrine causes
• Endocrine causes

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CAUSES OF SHORT STATURE

• Nonendocrine Causes
• Constitutional short stature
• Genetic short stature
• Intrauterine growth retardation and SGA
• Syndrome of short stature
• Turners syndrome and its variants
• Noonans syndrome (Pseudo-Turners syndrome)
• Prader-Willi syndrome
• Laurence-Moon and Bardet-Biedl syndrome
• Other autosomal abnormalities dysmorphic synd
• Chronic disease
• - Cardiac disorder
• Left to right shunt
• Congestive heart failure
• - Pulmonary disorders
• Cystic fibrosis
• Asthma
• - Gastrointestinal disorders
• Malabsorption (eg, celiac disease)

• Endocrine disorders
• GH deficiency and variants
• - Congenital GH deficiency
• - With midline defects
• - With other pituitary hormone deficiencies
• - Isolated GH deficiency
• - Pituitary agenesis
• - Acquired GH deficiency
• Hypothalamic-pituitary tumors
• Histiocytosis X
• Central nervous system infections
• Head injuries
• GH deficiency following cranial irradiation
• Central nervous system vascular accidents
• Hydrocephalus
• Empty sella syndrome
• - Abnormalities of GH action
• GH insensitivity (Larons dwarfism)
• Primary IGF-1 deficiency

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Normal variants

• Familial (genetic) short stature and
  constitutional short stature are common
  variations of normal.
• Individuals with familial short stature have a
  normal growth rate even though it is below the
  5th percentile
• They do not have skeletal delay, puberty and
  pubertal growth spurt occur at the usual
  chronological age, and final height is
  appropriate for mid-parental target height

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Normal variants

• Those with constitutional short stature have
  growth deceleration in the first two years of
  life, with normal growth velocity being achieved
  by age three and continuing throughout childhood
• Onset of puberty is usually delayed
• Adult height is in the normal range but varies
  according to parental height

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Non-endocrine causes

• Non-endocrine causes of short stature are
  commoner than endocrine causes
• Patients with non-endocrine disease tend to have
  normal body proportions
• Chronic malnutrition is the commonest cause of
  poor growth globally
• inflammatory bowel disease, coeliac disease, or
  anorexia nervosa
• Short stature is also commonly associated with
  renal disease, and conditions associated with
  hypoxia or hypoxaemia, such as congenital heart
  disease, pulmonary disease, and
  haemoglobinopathies
• Psychosocial deprivation often causes short
  stature. Placing the child in a different
  environment results in growth catching up.

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Endocrine causes

• Growth hormone deficiency or insufficiency is an
  uncommon cause of short stature
• Prevalence of the condition 1 in 4000
• Classic GH deficiency short stature, increased
  fat mass leading to a chubby appearance with
  immature facial, immature high-pitched voice, and
  delay in skeletal maturation.
• The calvarium seems to be relatively overgrown
  (delayed closure of fontanelles), with prominence
  of the frontal bone

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Endocrine causes

• The impairment of growth in Cushing's syndrome is
  predominantly the result of a direct effect at
  the growth plate. The commonest cause is
  iatrogenic (treatment with glucocorticoids), with
  endogenous glucocorticoid excess (Cushing's
  syndrome dependent on the pituitary and adrenal
  glands) being much rarer.

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Causes

• Several factors contribute to short stature,
  including
• Genetic factors (eg, skeletal dysplasias, Turner
  syndrome, Downs syndrome, Silver Russell
  syndrome)
• Endocrine disorders (eg, hypothyroidism, growth
  hormone deficiency)
• Delayed puberty (causes temporary short stature,
  but normal height is eventually achieved)
• Early puberty
• Malnourishment (on a global scale, this is the
  most common cause of growth failure and is
  generally associated with poverty)
• Chronic diseases
• Congenital heart disease
• Kidney diseases
• Asthma
• Sickle cell anemia
• Gastrointestinal disorders (eg, inflammatory
  bowel disease)
• Lung conditions ( cystic fibrosis, severe asthma,
  chronic obstructive pulmonary disease)
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HISTORY TAKING

• Initiating the session
• - Greeting, Introduce, obtain patients name,
  sex, date of birth, and
• Address
• Identifying the reason for the consultation
• - Chief complain
• - Explanation about hystory taking
• 3. Gathering information
• - History of present illness - Pregnancy
• - Birth History - History of Development
• - Family History - History of Disease
• - Medications - Diet
• - Accidents - Social
• 4. Closing

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History of present illness

• The onset
• Other symptom(s)

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Pregnancy

• Nutritional status
• Toxic or medication exposure
• Gestational age

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Birth History

• Delivery
• APGAR score
• Birth weight length

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History of Development

• Age of milestone sitting, walking, speaking
  words
• Educational achievement

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Family History

• Family member with short stature
• Consanguinity
• Height and weight of siblings
• Height and weight of parents
• Puberty

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History of Disease

• Gastrointestinal
• Lung
• Heart
• Kidney disease
• Anemia

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Medications

• Corticosteroids

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DIET

• Adequate food (quantity)
• Quality (healthful)

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Accidents

• Head

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SOCIAL

• Home interaction
• School interrelationship with schoolmates

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TERIMA KASIH