Endocrine

• Diminished/deficient secretion of pituitary hormones. Can lead to gonadotropin deficiency with absence or regression of sex characteristics, GH deficiency, TSH deficiency
• -Most common organic cause is tumors in pituitary or hypothalamic region
• -Clinical manifestations: short stature, appear well nourished, relatively inactive, eruption of permanent teeth delayed, overcrowded teeth, sexual development usually delayed but normal.

• Aimed at isolating organic causes in addition to GH deficiency, may include hypothyroidism, oversecretion of cortisol, gonadal aplasia, chronic illness, nutritional inadequacy...
• Complete diagnostic eval: history, history of growth patterns and previous health status, physical exam, psychosocial eval, radiographic surveys, and endocrine studies.
• *Definitive diagnosis is based on absent or subnormal reserves of pituitary GH

Treatment of GH deficiency is directed towards correction of underlying disease process. **Definitive treatment is replacement of GH, which is 80% successfull.

*identifying children with growth problems, establish diagnosis, provide education for pt self management (best when GH is given at bedtime)

• Excess GH before closure of epiphyseal shafts results in proprotional overgrowth of the long bones until the individual reaches 8 feet or more.
• -Vertical growth is followed with rapid and increased development of muscles and viscera, weight is proportional to height
• -If oversecretion of GH occurs after closure of epiphyseal plate, growth is in the transverse direction (acromegaly): big head, lips, nose tongue, jaw, increased facial hair,deeply creased skin, and tendency toward diabetesM.

Based on history of excessive growth during childhood and evidence of increased levels of GH. radiographic studies may reveal tumor, enlarged bones, evidence of joint changes...