In a 6-year-4-month-old girl with weight 27.5 kg, height 131.5 cm, BMI ~15.9 kg/m², and an advanced bone age of approximately 15 months, should a detailed endocrine evaluation be undertaken?

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Da li je ubrzana kostana dob od 15 mjeseci razlog za detaljnu endokrinološku pretragu?

Ne, ubrzana kostana dob od 15 mjeseci kod ove djevojčice sa normalnim rastom i BMI-jem nije sama po sebi indikacija za detaljnu endokrinološku pretragu.

Analiza kliničke slike

Ova djevojčica ima:

  • Visinu 131.5 cm što je iznad proseka za uzrast (6 godina 4 mjeseca)
  • Težinu 27.5 kg sa BMI ~15.9 kg/m² (normalan raspon)
  • Ubrzanu kostanu dob za ~15 mjeseci

Ključni parametri koji nedostaju za zabrinutost su:

  • Usporavanje brzine rasta
  • Smanjenje percentila visine tokom vremena
  • Gojaznost ili značajno povećanje težine
  • Znaci virilizacije ili prerane pubertete

Kada je endokrinološka pretraga indicirana?

Prema najnovijim smjernicama 1, skrining za Cushingov sindrom (najvažniji endokrinološki uzrok ubrzane kostane dobi) kod djece sa gojaznosti je indiciran samo ako je:

  • Povećanje težine neobjašnjivo I
  • Kombinovano sa smanjenjem SD skora visine ILI brzine rasta

Ova djevojčica ne ispunjava ove kriterijume jer nema gojaznost niti usporavanje rasta.

Šta pokazuju istraživanja o ubrzan kostnoj dobi?

Najrecentnije studije pokazuju:

  • Ubrzana kostana dob od ≥2 godine je česta kod premature adrenarhe (30.6% slučajeva) i generalno benigna 2
  • Predviđena odrasla visina ostaje normalna uprkos ubrzan kostnoj dobi 3, 2
  • Kod dječaka sa prekomjernom težinom/gojaznosti, ubrzana kostana dob je pozitivno korelirana sa BMI z-skorom 4, ali ova djevojčica ima normalan BMI
  • Ekstenzivno testiranje je nepotrebno samo zbog ubrzane kostane dobi 2

Praktični pristup

Preporučeni nadzor:

  • Praćenje brzine rasta svakih 3-6 mjeseci
  • Mjerenje visine, težine i BMI
  • Provjera da li se održava percentil rasta
  • Klinički pregled za znake virilizacije ili rane pubertete

Indikacije za endokrinološku pretragu bi bile:

  • Usporavanje brzine rasta (crossing percentiles nadolje)
  • Pojava znakova Cushingovog sindroma (centralna gojaznost + usporavanje rasta)
  • Znaci prerane pubertete (razvoj dojki prije 8 godina)
  • Znaci virilizacije (pubično dlakanje, akne, hirzutizam)

Važna napomena

Ubrzana kostana dob od 15 mjeseci kod djeteta sa normalnim rastom i normalnim BMI-jem najvjerovatnije predstavlja normalnu varijaciju ili blagu konstitucionalnu naprednost. Kod djece sa gojaznosti, ubrzana kostana dob je očekivana 4, 5, ali ova djevojčica nema gojaznost.

Zaključak: Nastavite sa rutinskim praćenjem rasta bez detaljne endokrinološke pretrage osim ako se pojave gore navedeni alarmantni znaci.

References

5
Research

Advanced bone age and hyperinsulinemia in overweight and obese children.

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2014

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