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Endocrine disorders associated with Frank obesity in a short child
(related to growth)
Male tanner scale Male external genitalia scale
Stage 1: Pre-pubertal
Stage 2: Enlargement of testes, thinning/reddening of
scrotum
Stage 3: Penis increases in length, testes enlarge
Stage 4: Penis increases in breadth, development of
glans, continued enlargement of testes
Stage 5: Adult male genetalia
Age of onset puberty- Female 8-13
- Breast budding
- Skeletal growth
,Female Tanner Scale Breast:
Stage 1: Pre-pubertal
Stage 2: Breast budding
Stage 3: Enlargement of breast and areola
Stage 4: Areola and papilla form secondary mound
Stage 5: Adult breast contour
Pubic hair:
Stage 1: No hair/ pre-pubertal
Stage 2: Scant hair along labia
Stage 3: Darker, coarse, curly hair spreads to central
region
Stage 4: Adult type hare on pubis not extending to
thighs
Stage 5: Adult type hair extending to medial thighs
What tanner stage female pts reach Height: Tanner stage 2-3
height velocity/ menarche Menarche: Tanner stage 4
Age tanner stage males reach height Tanner Stage 4
velocity
Constitutional Growth delay Delayed puberty or delayed bone age.
Can result in shorter stature, but pt can also have
normal height
Most common cause of short stature, true incidence
unk but up to 15% children referred to endocrinology
Males 2x as likely to be affected
, Constitutional Growth Delay Physical exam unremarkable
Symptoms/ PE/ testing
Normal wt/ length at birth
Slowing of velocity during first 3 years
Pubertal maturation and bone age delayed
Adult height usually normal target range
Labs: CBC, Sed rate, UA, Stool test, Eval L wrist (Bone
density/growth) - check for other potential etiologies
Constitutional Growth Delay Reassurance for parents
Management
Will probably end up with normal height
Psychosocial support for pt (low self esteem, poor
self image, social withdrawal)
Familial Short Stature definition/ PE/ Normal variation in growth pattern resulting in short
managment stature
Slowing growth velocity in first 3 years of birth
Decline in linear growth velocity
Bone age consistent w/ chronological age
Physical exam unremarkable, can test for other
potential conditions
Provide reassurance, psychological support