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Everyday lifestyle changes are a more realistic and effective way than dieting to manage weight and prevent long-term weight gain.
Management Summary
| 
|
|
Initial |
Annual |
2 yearly |
| Growth/ Short stature |
Height, Weight according to TS norms Record GH therapy | Height, Weight | |
| Blood Pressure | Blood Pressure (arms and leg) Treat hypertension | Blood Pressure (arms and leg) Monitor and treat hypertension | |
| Clinical Examination | Complete examination | Complete examination with reference to ongoing issues/ complication screening | |
| Cardiac | ECG, Echocardiogram. MRI if aortic dilation or echocardiogram not available Consider antibiotic prophylaxis Treat IHD risk factors Cardiologist review if aortic root dilatation | ECG, Echocardiogram if previously abnormal MRI if aortic root dilatation | |
| Renal | Ultrasound (if not previously performed) Creatinine clearance MSU Urinary microalbumin U&E, Creatinine Treat UTIs and hypertension Nephrologist review if abnormal | Hb, U+E, creatinine MSU if previously abnormal | Hb, U+E, creatinine Creatinine clearance MSU every 2 years if previously normal |
| Gynaecological | Breast examination If sexually active: Vaginal examination and Pap smear Pelvic/Vaginal Ultrasound Mammogram if 50 years or over Hormone Therapy | Breast examination | If sexually active: Vaginal examination and Pap smear Mammogram if 50 years or over |
| Thyroid function | TSH/Free T4 Thyroid antibodies | TSH Free T4 if TSH abnormal Treat hypothyroidism | |
| Hearing and ears | Audiology | ||
| G-I disease | LFTs Endomysial and transglutaminase antibodies Transdermal HT if abnormal LFTs | LFTs Referral to hepatologist if progressive elevations in LFTs | LFTs Endomysial and transglutaminase antibodies |
| Obesity, glucose tolerance | Waist circumference Fasting glucose and lipids Consider oGTT Low fat diet Exercise | Waist circumference Fasting glucose and lipids Low fat diet Exercise | |
| Bones | se Calcium, Phosphate, albumin, PTH, 25 hydroxy vitamin D Plain XR if indicated DEXA (hip, spine and total body-to assess fat mass) Calcium supplement: 1000- 1200 mg/day Vitamin D 400 IU/ day Exercise | 25 hydroxy Vitamin D | DEXA if osteopaenia on initial examination |
| Lymphoedema Webbing | Support stocking and physiotherapy | ||
| Vision (Squint, ptosis) | Opthalmology review | Opthalmology review | |
| Dental | Dental review | Dental review | |
| Psycho-social and education | Assessment of overall function Referral to Support groups and psychologist Vocational guidance Education re fertility |
|
|
5 yearly |
Pre-pregnancy |
|
| Growth/ Short stature |
Height, Weight | ||
| Blood Pressure | Blood Pressure (arms and leg) | ||
| Clinical Examination | Complete examination with reference to ongoing issues/ complication screening | ||
| Cardiac | ECG, Echocardiogram (if previously normal) | MRI. Cardiologist review mandatory | |
| Renal | Hb, U+E, creatinine Creatinine clearance MSU | ||
| Gynaecological | Breast examination Pap smear Vaginal ultrasound | ||
| Thyroid function | TSH, FreeT4 Thyroid antibodies | ||
| Hearing and ears | Audiology 2 yearly Or 3-5 yearly if normal audiology initially | ||
| G-I disease | LFTs Endomysial and transglutaminase antibodies | ||
| Obesity, glucose tolerance | Fasting glucose oGTT as per gestational diabetes screen | ||
| Bones | DEXA if normal BMD initially | ||
| Lymphoedema Webbing | |||
| Vision (Squint, ptosis) | |||
| Dental | |||
| Psycho-social and education | Counselling re fertility options/ risks. Referral to Fertility specialist |
Abbreviations used:
Hb - haemoglobin
U&E - urea and electrolytes
MSU - mid stream urine microscopy and culture
TSH - thyroid stimulating hormone
LFTs- liver function tests
oGTT - oral glucose tolerance test
se Ca - serum calcium
PTH - parathyroid hormone
Content June 04, 2007
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