1. Abnormalities of Growth (GH) Lecture NO: 2nd MBBS
Dr Muhammad Ramzan

2. GH abnormalities – the definition
It refers to the conditions when level of GH is found to be higher or lower than normal body requirements
GH is important for children to grow or adults to have a comfortable life

3. Abnormalities of GH – Causes/ lesions GH production and receptor binding
GH deficiency and excess has a very important role of this hormone in normal physiology
Such disorders can result from lesions either in the :
Hypothalamus or the pituitary affecting production or 1
Target cells for Receptor binding

4. GH abnormalities – Types excess and deficiency
GH may be secreted in excess or there can be deficiency of GH with different clinical manifestations
GH abnormalities can occur both in children and adults
Excess of GH: Giantism in children and Acromegaly in adults
Deficiency of GH: Dwarfism in children – Rare in adults

5. Deficiency of GH – the types Hereditary or acquired
The manifestations of GH deficiency depends upon:
The age of the of onset of the disorder or
The cause whether it is heritable or acquired disease
GH deficiency results Dwarfism in children
GH deficiency is rare in adults

6. Deficiency of GH in children Dwarfism
Deficiency of GH in children produces a condition called Dwarfism
GH is secreted less than the body requirements
Dwarfism is commonly associated with Panhypopituitrism
It is a total failure of Pituitary in children

7. Dwarfism – Special features 1 Appropriate proportion of body parts
All the physical body parts like size of hands and feet develop in appropriate proportion to each other but 1
The rate of development is greatly reduced, ≥ 4 feet 2
The affected child appears to be younger than his actual age
A child at the age of 10 years may have body development of a child aged 4 -5 – years

8. Dwarfism – special features 2
A dwarf individual may not pass through puberty as he
never secretes sufficient quantity of Gonadotropins
GH in these children may be sufficient but there will be deficiency of IGF-1 – an active metabolite of GH 1

9. Dwarfism 0r growth retardation in children

10. GH deficiency in Adults – is rare
It results in reduction of muscle mass, visceral fat deposition and osteoporosis
Leads to abnormal lipid profile

11. GH excess – Types. 2. (age) In children and adults
GH is secreted more than body requirements
The effects of GH excess depend on the age of onset, both in children and adults – 2 conditions
Giantism or Gigantism : This condition occurs in children when epiphysis are not Fused
Acromegaly: when epiphysis are fused in adults

12. GH excess in adults – Acromegaly excess of GH/IGF-1
Acromegaly results from excessive secretion of growth hormone in adults with fused epiphysis
It is usually the result of benign pituitary adenoma in middle aged individuals
Excessive secretion of GH leads to excessive generation of IGF-1 - the mediator for the effects of GH

13. Acromegaly – No ↑in height ↑in soft tissue /viscera
There is no ↑ in height but soft tissue proliferation.
There is Enlargement of bones of hands and feet with swelling
Over growth of the Skull, lower jaw and bulging of forehead
Prominent nose, thick lips and tongue
↑ in the size of the viscera like Liver and heart

14. Acromegaly –↑ in bone thickness and soft tissues

15. Acromegaly - Wide sole of foot

16. Acromegaly – Large skull, lower jaw, prominent nose and bulging forehead

17. GH excess in Children- Giantism when epiphysis are not fused
Giantism in children and adolescents occurs when epiphysis are not fused
Chronic GH secretion leads to linear growth of long bones usually to 7- 9 feet
Hyper secretion of GH is commonly associated with hypogonadism and cause of non fusion of epiphysis

18. Gigantism
7 feet 8 inches
Pituitary gland tumor

19. Difference B/W Acromegaly and Giantism