Kuliah Gangguan Pertumbuhan PBL
Kuliah Gangguan Pertumbuhan PBL
PERTUMBUHAN PADA
ANAK
Gangguan pertumbuhan
G ro w th C h a rt Perawakan normal
195
190
185
97 pertumbuhan
terganggu
180
175 50
170
165 3
160
155
150
145
H e ig h t 140
(c m ) 135
130
125
120
115
110
105
100
95
90
85
80
2 4 6 8 10 12 14 16 18
A g e (y e a rs )
Gangguan pertumbuhan
G ro w th C h a rt Perawakan pendek
195
190
185
97 pertumbuhan normal
180
175 50
170
165 3
160
155
150
145
H e ig h t 140
(c m ) 135
130
125
120
115
110
105
100
95
90
85
80
2 4 6 8 10 12 14 16 18
A g e (y e a rs )
ETIOLOGI PERAWAKAN
PENDEK
Perawakan pendek dapat disebabkan oleh kelainan
endokrin ataupun non endokrin seperti
Genetik atau familial
Kelainan kromosom atau sindrom tertentu
Penyakit kronis
Gangguan gizi
Deprivasi psikososial
Skeletal disorder
Intra Uterine Growth Retardation (IUGR)
Constitutional Delay of Growth and Pubeerty (CDGP)
Kelainan endokrin : defisiensi GH, Hipotiroidisme, dll.
PERAWAKAN PENDEK
YA TIDA
K
PROPORSI ? DISMORFISM ?
BB/TB?
PERAWAKAN PENDEK
PATOLOGIS
PROPORSIONAL
DISPROPORSIONAL
BB/TB BB/TB
KELAINAN
ENDOKRIN
•MALNUTRISI DISMORFIK
•DEFISIENSI GH
•INFEKSI KRONIS
•HIPOTROID
•PENYAKIT
•KORTISOL KRONIS
•PSEUDOHIPOPARA (ORGANIK)
TIROID •PSIKOSOSIAL
•IUGR
PERAWAKAN PENDEK
PATOLOGIS
VARIAN NORMAL
Rosenfeld et al (1994)
Pemberian dini terapi GH
Kombinasi GH + oxandrolone
Estrogen induksi pubertas
Penatalaksanaan
Familial short stature : tidak diterapi
Constitutional delay of growth and puberty
(CDGP): tidak diterapi
Tergantung kausal : nutrisi, infeksi, dll
Hormonal : GH, tiroid, sex steroid
Dysproporsional SS : achondroplasia,
osteogenesis imperfecta, sindr. Down, dll;
tidak diterapi
Anak umur 5 tahun ,)
Tall Stature
Introduction
Definition
Tall stature : height above 97th percentile
for age, sex and race.
GH excess, occurs during childhood when
open epiphyseal growth plates allow for
excessive linear growth
Cause
Intrinsic
Acquired
Growth cessation
185
180
175
170
165
160
155
150
145
Height 140
(cm) 135
130
125
120
115
110
105
100
95
90
85
80
2 4 6 8 10 12 14 16 18
Age (years)
Grow th Chart
195
Constitutional Delay of Growth & Puberty
190
185
180
175
170
165
160
155
150
145
Height 140
(cm) 135
130
125
120
115
110
105
100
95
90
85
80
2 4 6 8 10 12 14 16 18
Age (years)
Normal Variant Short
Stature
FSS CDGD
Bone Age <1 yr from CA >1 yr from
CA
Puberty On time Delayed
Final Height Short Normal
Pathological short stature
Proportionate: IUGR
syndromes
chronic illness
drugs
psychsocial deprivation
Disproportionate: Syndromes (partic Turner
S)
hypothyroidism
IUGR/SGA
Intrauterine growth retardation or small for
gestational age.
Very common.
Birth weight <10th PC for gestational age.
Catch-up growth above 3rd PC usually
occurs by 6 mos of age but may drag on to
2 yrs.
Short stature by 2 yrs usually associated
with short final height.
As a group these children do not reach
Turner Syndrome
Chromosome
47, XYY; Klinefelter syndrome (46, XXY);
Fragile X syndrome
Beckwith-Wiedemann syndrome (IGF2)
Weaver syndrome
Simpson-Golabi-Behmel syndrome (GPC3)
Bannayan-Riley-Ruvalcaba syndrome (PTEN)
Deficiency of aromatase/loss of function
mutations of estrogen receptor (a) in male
Acquired tall stature
Infant of diabetic mother (hyperinsulinism)
Obesity (tall child normal adult height)
Sexual precocity (tall child but short adult)
Primary hypogonadism (eunuchoid)
Hyperthyroidism
FT4, TSH
LED, darah rutin (CBC)
Elektrolit, BUN, creatinin, urinalisis,
tinja
Skrining TBC
Umur tulang (bone age)
Rujuk untuk pemeriksaan GH / IGF-1
ACHONDROPLASIA
HIPOTIROID
DIDAPAT
HIPOTIROID
KONGENITAL
KESIMPULAN
Pertumbuhan menggambarkan keadaan
kesehatan seorang anak
Pemantauan pertumbuhan memerlukan
pengukuran teratur dengan alat yang
tepat,
penting interpretasi hasil pemantauan
Perlu diingat bahwa gangguan
pertumbuhan
lebih sering disebabkan oleh kelainan
non-endokrin