Treatment of children with short stature

Short stature treatment programName of diseaseClinical manifestationdiagnostic criteriaInspection itemRecommended doseMedication timecurativ

Content

Short stature treatment program

Name of disease

Clinical manifestation

diagnostic criteria

Inspection item

Recommended dose

Medication time

curative effect

Matters needing attention

GHD (growth hormone deficiency)

1 developmental delay: short stature;

2 the appearance is smaller than the actual age;

3 prominent forehead, high tone;

4 good nutrition, a little fat, intelligence is normal;

5 sexual immaturity

6 bone age backward

1 lower than the same age, the same sex of children with -2SD or less than third percentile;

2 year growth rate is lower than 4cm or height growth rate SDS < -1;

3 symmetrical short, no signs of puberty;

Except for 4 of chronic kidney disease, hypothyroidism, diabetes mellitus;

5 bone age backward at the age of 2 or above;

6 growth hormone stimulation test: GH< (10ng/ml) GH; (a) < complete absence of 5ng/ml; (b) 10ng/ml> GH > partial deficiency of 5ng/ml;

1 routine examination: blood routine, liver and kidney function, etc.;

2 left hand X-ray bone age: understanding;

3 thyroid function;

4 fasting blood glucose;

5 pituitary MRI/CT;

6 growth hormone stimulation test;

1 before puberty: 0.1-0.15IU/kg/d; 2 in adolescence: 0.15-0.2IU/kg/d;

Three months for an observation period; 2 years of treatment at least; treatment should be continued to allow pediatric epiphyseal fusion so far;

Match water agent: fast onset, good long-term effect, the average growth rate of 10-14cm/y.

1. The height and weight were measured every 3 months;

2 hypothyroidism, thyroid hormone tablets should be added;

3 water sodium retention symptoms: edema of the eyelids, hands and feet are swollen, leg edema; benign intracranial hypertension symptoms; joint pain or muscle pain; tolerance can continue to use, can not tolerate the withdrawal symptoms, recovery of medication; above symptoms in general medication 1 months away.

CPP (central or true precocious puberty)

1 height growth accelerated;

2 age early, early fusion of epiphysis, reduced final height;

3 secondary sexual characteristics in normal pubertal age, with increasing development and gonad until sexual maturity, with fertility;

1 secondary sexual characteristics appear in advance;

2 serum gonadotropin (Gn) levels reached puberty level, gonadotropin (a) based value: if the secondary sexual characteristics has reached the youth level, LH> 5.0IU/L, can determine the gonad axis has been launched, do not need the GnRH stimulation test; (b) GnRH stimulation test of gonadal axis the function has started Gn base value rise is an important diagnostic means;

Diagnosis of LH peak value of CPP: LH peak girl > 12 IU/L, boy > 25 IU/L, LH/FSH peak > 0.6~1.0;

3 gonad enlargement; linear growth acceleration of 4;

5 age beyond the actual age of 1 years or 1 years; 6 serum sex hormone levels increased to the level of adolescent;

1 routine examination: blood routine, liver and kidney function, etc.;

2 left hand X-ray bone age: understanding;

3 thyroid function;

4 fasting blood glucose;

5 women do B: to understand the situation of the ovary and uterus;

6 pituitary MRI/CT;

7.GnRH excitation test;

0.15-0.2IU/Kg/d

Three months was an observation period; the treatment period was more than 1 years;

Match water agent: fast onset, good long-term effect, the average growth rate of 7-9cm/y.

1. The height and weight were measured every 3 months;

2 treatment of sodium and water retention symptoms;

3 single treatment with growth hormone should not be used, indications for GnRHa:  bone age girl aged 12.5, boys aged 13.5; ‚ girls after menarche or spermatorrhea boy after one year.

Idiopathic short stature (ISS)

1 birth was not associated with a history of dystocia or hypoxia;

2 normal body;

3 no chronic organic disease;

4 without mental illness or serious emotional disturbance;

5 normal diet;

1 there is no classic cause of dwarfism;

2 growth retardation, lower than the standard deviation of two;

3 may have delayed bone age, bone age can also be normal;

4 with delayed puberty or similar family history;

5 growth hormone stimulation test in the normal range.

1 routine examination: blood routine, liver and kidney function, etc.;

2 left hand X-ray bone age: understanding;

3 thyroid function;

4 fasting blood glucose;

5 pituitary MRI/CT;

6.GnRH excitation test;

0.15-0.2IU/Kg/d

Three months for an observation period; 2 years of treatment at least; treatment should be continued to allow pediatric epiphyseal fusion so far;

Match water agent: quick onset, long term effect is good; the average final height is higher than the predicted lifetime 5-8cm;

1. The height and weight were measured every 3 months;

2 treatment of sodium and water retention symptoms;

SGA (small for gestational age)

1 catch-up growth and short stature;

2 metabolic abnormalities: insulin resistance and metabolic syndrome;

3 psychosocial dysfunction;

The birth weight and (or) length below the normal reference value of the same gestational age -2 SD or the third percentile of the newborn.

1 routine examination: blood routine, liver and kidney function, etc.;

2 left hand X-ray bone age: understanding;

3 thyroid function;

4 fasting blood glucose;

5 pituitary MRI/CT;

0.15-0.2IU/Kg/d

Three months for an observation period; 2 years of treatment at least; treatment should be continued to allow pediatric epiphyseal fusion so far;

Match water agent: quick onset, long-term effect is good; timely, long-term application can catch up growth, so that the final height normalization

1. The height and weight were measured every 3 months;

2 treatment of sodium and water retention symptoms;

Turner syndrome

1: birth length / body weight growth lagged behind, 2 ~ 3 years old growth significantly slow puberty behind obvious bone maturation and delayed epiphyseal fusion, adult height of 135 ~ 140cm;

2 dysplasia: infantile genitalia, ovarian tissue is a fiber bundle replacement;

3 special physical signs;

1 slow growth, bone age backward;

2 height in the normal female growth curve of fifth percentile below;

3 sex naive: B ultrasound for the beginning of the uterus, the ovary was a cable like;

4 karyotype was 45XO, or chimeric;

The 5 part of patients with low GH levels;

1 routine examination: blood routine, liver and kidney function, etc.;

2 left hand X-ray bone age: understanding;

3 thyroid function;

4 fasting blood glucose;

5 pituitary MRI/CT;

6 chromosome examination;

0.15-0.2IU/Kg/d

Three months for an observation period; 2 years of treatment at least; treatment should be continued to allow pediatric epiphyseal fusion so far;

Match water agent: rapid onset, good long-term effect; annual growth rate can be increased by 50%~150%, the final height of more than 150cm.

1. The height and weight were measured every 3 months;

2 treatment of sodium and water retention symptoms;

 

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