My 6-yr old has been under the care of a pediatric endocrinologist for 18 months due to growth issues. She's fallen to 0.8% on the growth chart in both height and weight. She is now on an appetite stimualt, which seems to be helping her eat more; however, she still doesn't seem to be growing like she should. The endocrinologist started by doing a standard blood test to check her hormone levels, as well as testing for Turner syndrome and celiac deisease. Everything came back normal, so we have simply been monitoring her growth and returning to the endocrinologist every 4-6 months. The next step at the beginning of May, if she has not made better progress, is to do the 3-hr specialized blood test to specifically test her growth hormone. The endocrinologist has mentioned growth hormone replacement therapy, asking us to be thinking about this as a possible treatment plan down the road.
A few months ago, we noticed that she also has fine hand tremors. They are usually barely noticeable; however, they are significantly worse in the morning or when she is tired. When we noticed this symptom, I called my daughter's endocrinologist, and she had us go see the pediatrician. Our pediatrician has referred us to a pediatric neurologist, and we go at the end of April. I can't help but think that the tremors may be a symptom of what is also causing the growth issues, and my biggest concern now is knowing what questions to ask both specialists so that we can finally put all the pieces of the puzzle together. Do you know what tests, if any, the neurologist will run at our initial visit? What questions should I ask both the neurologist and endocrinologist? We go to the neurologist a week before our endocrinology check-up; should I request a copy of my daughter's medical records from the endocrinologist to bring with us or drop by the neurology office before we go so that we can make the most of our limited time with the doctor?
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.
There are several types of tremors. Some include essential tremor (which is a tremor with movement and with posture), parkinsonian (resting tremor), enhance physiological tremor (normal tremor that is inherent in all people that is exacerbated with stress), etc. The diagnosis of tremor is typically a thorough neurological examination. The physician may order tests that include thyroid stimulating hormone and routine labs. Rarely is much more information needed to make a diagnosis. Some may order neuroimaging of the brain if indicated. Lastly, it would be useful to have your daughter’s endocrinological labs with you as well. These would be helpful for the neurologist.
Thank you for using the forum, I hope you find this information useful, good luck.
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