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{{Growth hormone deficiency}}
{{Growth hormone deficiency}}
{{CMG}}
{{CMG}}; {{AE}} {{MAD}}


==Overview==
==Overview==
==Physical Examination==
Patients with growth hormone deficiency usually look tired and less energetic than normal subjects.  Extremities show [[Clubbing]], [[muscle atrophy]], [[neonatal jaundice]], [[Cyanosis|neonatal cyanosis]]. Head may show infantile facies, [[Dentition|delayed dentition]], and brittle hair. Children may show [[hyporeflexia]] and [[delayed puberty]].
===Appearance===
In children,
* Proportional stature well below that expected for family heights
* Below-normal velocity of growth
* Delayed physical maturation
*Mild to moderate chubbiness
*Cherubic facial features characterized by [[maxilla]]ry hypoplasia and forehead prominence (said to resemble a kewpie doll).      
 
===Neurologic Examination===
In adults,
* Diminished muscle strength
 
===Genitourinary system===
*[[Micropenis]]


When these features are accompanied by corroboratory evidence of [[hypopituitarism]] such as deficiency of other pituitary hormones, a structurally abnormal pituitary, or a history of damage to the pituitary, the diagnosis is confirmed and presumed to be lifelong. When these corroborative features are not present, further testing is needed to establish the diagnosis.
==Overview==
*Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
*Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
==Physical Examination==
==Physical Examination==


*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
===Appearance of the Patient===
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*Children with growth hormone deficiency usually look tired and less energetic than normal subjects of the same age with infantile doll-like body shape. 
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
*In adults, increased lean [[body mass]] causes [[weight gain]], especially around the [[waist]].<ref name="pmid25070016">{{cite journal| author=Fukuda I, Hizuka N, Muraoka T, Ichihara A| title=Adult growth hormone deficiency: current concepts. | journal=Neurol Med Chir (Tokyo) | year= 2014 | volume= 54 | issue= 8 | pages= 599-605 | pmid=25070016 | doi= | pmc=4533495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25070016  }}</ref>


===Appearance of the Patient===
=== Back ===
*Patients with [disease name] usually appear [general appearance].  
* [[Osteoporosis]] and tenderness of the [[Lumbar spine|lumbar spine]] are higher in patients compared with normal subjects.<ref name="pmid22157400">{{cite journal| author=Stanley T| title=Diagnosis of growth hormone deficiency in childhood. | journal=Curr Opin Endocrinol Diabetes Obes | year= 2012 | volume= 19 | issue= 1 | pages= 47-52 | pmid=22157400 | doi=10.1097/MED.0b013e32834ec952 | pmc=3279941 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22157400  }}</ref>


===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*[[Hypothermia]] associated with [[hypothyroidism]]
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
*[[Cyanosis]]  
*[[Cyanosis]] in neonates
*[[Jaundice]]
*[[Jaundice]] in neonates
* [[Pallor]]
* Bruises
 
<gallery widths=150px>
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
* Infantile facies
* Evidence of trauma
* Delayed [[Dentition|dentition]]
* Icteric sclera
* Brittle hair.
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae / tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally due to the high rate of [[atherosclerosis]].<ref name="pmid26550626" />
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
===Abdomen===
*[[Abdominal distention]]  
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*[[Cryptorchidism]] and [[micropenis]] in infants<ref name="pmid27974187" />
*Inflamed mucosa
*[[Delayed puberty]] in children<ref name="pmid26550626">{{cite journal| author=Nielsen J, Jensen RB, Afdeling AJ| title=[Growth hormone deficiency in children]. | journal=Ugeskr Laeger | year= 2015 | volume= 177 | issue= 26 | pages= 1260-3 | pmid=26550626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26550626  }}</ref>
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
* [[Hyporeflexia]]
* Altered mental status
* [[Muscle weakness]] bilaterally
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
*[[Clubbing]]  
*[[Clubbing]]  
*[[Cyanosis]]  
*[[Cyanosis]] [[Cyanosis|in neonates]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*[[Jaundice]] in neonates
*Muscle atrophy
*Pitting/non-pitting [[edema]]
*Fasciculations in the upper/lower extremity
*[[Muscle atrophy]]<ref name="pmid27974187">{{cite journal| author=Chinoy A, Murray PG| title=Diagnosis of growth hormone deficiency in the paediatric and transitional age. | journal=Best Pract Res Clin Endocrinol Metab | year= 2016 | volume= 30 | issue= 6 | pages= 737-747 | pmid=27974187 | doi=10.1016/j.beem.2016.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27974187  }}</ref>


==References==
==References==

Latest revision as of 20:21, 26 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Overview

Patients with growth hormone deficiency usually look tired and less energetic than normal subjects. Extremities show Clubbing, muscle atrophy, neonatal jaundice, neonatal cyanosis. Head may show infantile facies, delayed dentition, and brittle hair. Children may show hyporeflexia and delayed puberty.

Physical Examination

Appearance of the Patient

  • Children with growth hormone deficiency usually look tired and less energetic than normal subjects of the same age with infantile doll-like body shape.
  • In adults, increased lean body mass causes weight gain, especially around the waist.[1]

Back

Vital Signs

Skin

HEENT

  • Infantile facies
  • Delayed dentition
  • Brittle hair.

Neck

Abdomen

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ Fukuda I, Hizuka N, Muraoka T, Ichihara A (2014). "Adult growth hormone deficiency: current concepts". Neurol Med Chir (Tokyo). 54 (8): 599–605. PMC 4533495. PMID 25070016.
  2. ↑ Stanley T (2012). "Diagnosis of growth hormone deficiency in childhood". Curr Opin Endocrinol Diabetes Obes. 19 (1): 47–52. doi:10.1097/MED.0b013e32834ec952. PMC 3279941. PMID 22157400.
  3. ↑ 3.0 3.1 Nielsen J, Jensen RB, Afdeling AJ (2015). "[Growth hormone deficiency in children]". Ugeskr Laeger. 177 (26): 1260–3. PMID 26550626.
  4. ↑ 4.0 4.1 Chinoy A, Murray PG (2016). "Diagnosis of growth hormone deficiency in the paediatric and transitional age". Best Pract Res Clin Endocrinol Metab. 30 (6): 737–747. doi:10.1016/j.beem.2016.11.002. PMID 27974187.

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