《儿科学》课程教学资源（授课教案）15 Growth Hormone Deficiency

重庆医科大学儿科学教案讲课题目教师：熊丰授课题目Growth hormone deficiencyTEACHINGTOPIC第几次课TIMES4 times教学方法METHODSLecture教学对象Grade 2002/2003/2005/2006OBJECTIVE学时：TIME40min ×1教学目标PURPOSEUnderstand the clinical features of Growth hormonedeficiency.Be able to discuss the diagnosis and management教学重点和难点Emphasis:PURPOSEIDIFFICULTIESClinical manifestation,LaboratoryexaminationDiagnosis and differential diagnosis,Treatment教学内容的深化与拓宽For better understandjincrease the knowledge aboutThe developments physiology features of growth Hormone教学要求的英语单词Growth hormone deficiencyEnglish requirementspituitary dwarfismgrowth Hormone(GH)insulin-like growth factor-1实践性教学安排See patient or teaching video

重庆医科大学儿科学教案 讲课题目 教师：熊丰 授课题目 TEACHING TOPIC Growth hormone deficiency 第几次课 TIMES 4 times 教学方法 METHODS Lecture 教学对象 OBJECTIVE Grade 2002/2003/2005/2006 学时: TIME 40min x 1 教学目标 PURPOSE Understand the clinical features of Growth hormone deficiency. Be able to discuss the diagnosis and management 教学重点和难点 PURPOSE/ DIFFICULTIES Emphasis: Clinical manifestation, Laboratory examination Diagnosis and differential diagnosis, Treatment 教学内容的深化与拓宽 The developments For better understand,increase the knowledge about physiology features of growth Hormone 教学要求的英语单词 English requirements Growth hormone deficiency pituitary dwarfism growth Hormone(GH) insulin-like growth factor-1 实践性教学安排 See patient or teaching video

Clinical study教材及参考资料TextbookTEXT BOOK USEDIREFERENCES沈晓明主编，《儿科学》第7版，人民卫生出版社，2008年孙琨主编《小儿内科学》第4版，人民卫生出版社，2009年Reference胡亚美,江载芳。诸福棠实用儿科学.第7版.北京：人民卫生出版社,2002Behrman RE, Kliegman RM and Jenson HB. Nelson textbookof pediatrics.16th ed. Science Press, Harcourt Asia, W.B.Saunders, 2001教具TEACHINGAIDS详细见讲稿主要内容及安排教学程序 Procedures（教学内容详细安排、教学方法的运用、师生活动设计、及时间分配）：讲稿主要内容及安排备注（授课形式）时间安排（分钟）Growth hormone deficiency40 PPT2[Overview]1.Growth hormone deficiency (GHD)occurs when anteriorIntroducepituitary synthesize and secrete growth hormone insufficient,Definition2.clinic features, emphasize on disorders of growth andIncidencedevelopmen3. incidence[Synthesis and Release of growth Hormone]3

Clinical study 教材及参考资料 TEXT BOOK USED/ REFERENCES Textbook 沈晓明主编，《儿科学》第 7 版，人民卫生出版社，2008 年 孙琨主编《小儿内科学》第 4 版，人民卫生出版社，2009 年 Reference 胡亚美,江载芳. 诸福棠实用儿科学.第 7 版.北京:人民卫生出版 社,2002 Behrman RE, Kliegman RM and Jenson HB. Nelson textbook of pediatrics.16th ed. Science Press, Harcourt Asia, W.B. Saunders, 2001 教具 TEACHING AIDS 详细见讲稿主要内容及安排 教学程序 Procedures （教学内容详细安排、教学方法的运用、师生活动设计、及时间分配）： 讲稿主要内容及安排 备注（授课形式） 时间安排 （分钟） Growth hormone deficiency PPT 40 [Overview] 2 1. Growth hormone deficiency (GHD) occurs when anterior pituitary synthesize and secrete growth hormone insufficient, Introduce: Definition 2.clinic features, emphasize on disorders of growth and Incidence development. 3. incidence [Synthesis and Release of growth Hormone ] 3

1Review synthesisrelease of growth hormone, and insulin-likeIntroducesynthesisCrelease of GH and IGF-1 letgrowth factor-1.student understand the roleof GH and IGF-12.ReviewHypothalamus-pituitary-growth axis regulate GHlationandfeedbackregulationTheroleofsecretion,positivgrowth hormone releasing hormone (GHRH) and growth hormoneinhibitinghormone（GHIH）let studentknowthe[Etiology]frequence of eachetiology.1. Idiopathic hypopituitarism:major causeAbnormality of Neurotransmiter-neurohormone pathway2.Secondary hypopituitarismCraniocerebral tumor, infection,trauma, brain radiation injury53. Hereditary pituitary maldevelopment4. Other causestemporalitygrowthretardationGH receptor deficiency::laronSyndromIGF-1 receptor deficiency: African Pygmy peopleBy review physiology of[GH physiology]GH,let students know GHPulse secretionsecretion features and easyCircadianunderstand GH provocative2sep,rcise, staaton increasetheGH serettest latter.Come drugs stimulate the GH secretionpromotes skeleton growingShowdifferent photos of[clinical manifestation]CH.Growth retardation8Unusual faciesNormal intelligenceDelayed pubertyEmphasizerugon[auxiliary examination]5provocative test, it is very

1. Review synthesis ,release of growth hormone, and insulin-like growth factor-1. Introduce: synthesis and release of GH and IGF-1 let student understand the role of GH and IGF-1 2. Review Hypothalamus-pituitary-growth axis regulate GH secretion, positive regulation and feedback regulation.The role of growth hormone releasing hormone（GHRH）and growth hormone inhibiting hormone (GHIH）. [Etiology] let student know the frequence of each etiology. 5 1. Idiopathic hypopituitarism: major cause Abnormality of Neurotransmitter-neurohormone pathway 2. Secondary hypopituitarism Craniocerebral tumor, infection, trauma, brain radiation injury 3. Hereditary pituitary maldevelopment 4. Other causes temporality growth retardation GH receptor deficiency: laron Syndrome IGF-1 receptor deficiency: African Pygmy people [GH physiology] By review physiology of GH,let students know GH secretion features and easy understand GH provocative test latter. 2 Pulse secretion Circadian sleep, exercise, starvation increase the GH secretion Come drugs stimulate the GH secretion promotes skeleton growing [clinical manifestation] Show different photos of CH. 8 Growth retardation Unusual facies Normal intelligence Delayed puberty [auxiliary examination] Emphasize on drug provocative test, it is very 5

Laboratory findingsimportanceearlySerum GH determinationdiagnosis.Screening test Drug provocative testSerum level of IGF1:LowerBone age (BA)Head CT,MRI:exclude intracranial tumor,encephalodysplasi[Diagnosis and Differential diagnosis]10diagnostic criteriaEmphasize on diagnosisShort stature: height below 2 SD or 3rdcriteriaDfferential diagnosis focuspercentileGrowth velocity less than 5 cm /yron diseases which areNormal intelligenceeasy Confusing with GHDBA delayed more than 2 yearTwo drugs provocative test, post-stimulusserumGH values less than 10 ug/LDifferential ddiagnosiConstitutional delayed puberty and growthFamilial short staturIdiopathic short statureTurner's syndrome5[Treatment]GH therapyEmphasize on early treat asAnabolic hormoneearly as possible.Multiplepituitaryblementaltherapies[结课]Summarize the content of this lesson , repeat the emphasisGive the content of review after the lesson

Laboratory findings Serum GH determination Screening test Drug provocative test Serum level of IGF1: Lower Bone age (BA) Head CT,MRI: exclude intracranial tumor, encephalodysplasia importance for early diagnosis. [Diagnosis and Differential diagnosis] 10 diagnostic criteria Short stature: height below 2 SD or 3rd percentile Growth velocity less than 5 cm /yr Normal intelligence BA delayed more than 2 year Two drugs provocative test, post-stimulus serum GH values less than 10 ug/L Differential diagnosis: Constitutional delayed puberty and growth Familial short stature Idiopathic short stature Turner’s syndrome Emphasize on diagnosis criteria. Differential diagnosis focus on diseases which are easy Confusing with GHD [Treatment] 5 GH therapy Anabolic hormone Multiple pituitary hormone supplemental therapies Emphasize on early treat as early as possible. [结课] Summarize the content of this lesson，repeat the emphasis. Give the content of review after the lesson

Review points :I) Etiology?2) Clinic feature ofGHD3) Drug provocative testDiagnosis anddifferent diagnosis of GHD5) Treatment ofGHD.总结及补充修正授课年级总结及修正补充内容备注Grade 2002Increase the GH functionincrease the knowledge of IGF-1Grade2003Grade 2005Increase the GHmolecular structureGrade 2006Increase GH physiology

Review points： 1) Etiology？ 2) Clinic feature of GHD 3) Drug provocative test 4) Diagnosis and different diagnosis of GHD. 5) Treatment of GHD. 总结及补充修正 授课年级 总结及修正补充内容 备注 Grade 2002 Increase the GH function Grade 2003 increase the knowledge of IGF-1, Grade 2005 Increase the GH molecular structure Grade 2006 Increase GH physiology