With the development of the society and the improvement of the living standard of the people, the number of consultations for children with short stature is gradually increasing, especially during the holiday season, when the number of children attending the clinic increases dramatically. At the clinic, many parents of children with short stature have the following questions: What tests are needed? What is the purpose of these tests? Parents are concerned about their children’s height, but if they do not understand the general medical knowledge and are not prepared for the visit, they often fail to arrange the examinations in a reasonable way, which leads to waste of time. In addition, parents would like to have their questions answered by the physician during the consultation, but due to the limited time available for outpatient consultation, they may not be able to answer in detail. Therefore, I would like to provide some answers to the flow of the consultation for children with dwarfism and related issues for the reference of parents and children.
First of all, we will measure the height and weight. When measuring the height, please take off your shoes, stand straight and relax. Reason: Through the hospital’s professional height measuring instruments, the child’s height is measured accurately and precisely.
Then, ask for medical history: family situation, parents’ height, mother’s pregnancy, child’s birth history, past diseases and medication history, etc. Then comes the physical examination: including intelligence, facial appearance, body shape, body proportion, and examination of important organs, and examination of the development of secondary sexual characteristics.
The following are laboratory tests: 1) routine blood and urine tests, liver and kidney functions, blood glucose; 2) bone age; 3) MRI of the pituitary gland (to see the size of the pituitary gland and whether there are any occupational lesions); 4) thyroid function, insulin-like growth factor-1 and insulin-like growth factor binding protein-3 tests; 5) growth hormone stimulation test; 6) chromosome examination (if necessary); 7) ultrasound of the adrenal glands (if necessary), etc. If necessary), etc.
Why should we do these tests?
1.Bone age film: For short children, the first thing you need to do is to take an x-ray of the left wrist and metacarpal finger (bone age film) to understand the bone age, determine the bone growth of the child, the degree of epiphyseal closure (if the epiphysis is closed, no more treatment is possible) and the growth potential, especially through detailed assessment of bone age and into the annual height prediction is very important to know how high the child can grow without treatment, in order to know whether treatment is needed or determine a more reasonable Treatment plan.
2.Blood routine, liver and kidney function, blood sugar and thyroid hormone: check whether there are chronic diseases and hypothyroidism caused by dwarfism; in addition, poor liver and kidney function itself also affects children’s growth.
3. Growth hormone stimulation test: Growth hormone is secreted in the body in pulses, and the usual value is very low, only 3 to 5 peaks appear during deep sleep at night, and the child may wake up during night blood collection, and the number of blood collection is long, so it is not used. Random blood collection cannot detect the peak level and cannot reflect whether growth hormone is normal, so growth hormone stimulation test is performed.
4. Chromosomes and magnetic resonance: Chromosomes should be checked in undeveloped girls to rule out congenital ovarian hypoplasia (Turner syndrome), and chromosomes may be checked in a very small number of boys. MRI or CT of the pituitary gland is usually needed to rule out factors that are not suitable for growth hormone application, such as pituitary tumors.