An international symposium on idiopathic dwarfism (ISS) was held in Santa Monica, California, USA, from October 17 to 20, 2007, where top experts in the field and representatives of all international pediatric endocrine societies were invited to participate in the drafting of a common statement on ISS. The statement is briefly excerpted below.
In clinical treatment, idiopathic dwarfism (ISS) is one of the more common types of short stature children, accounting for about 60-80% of the children in the Department of Pediatrics, Nantong Hospital of Traditional Chinese Medicine, Ge Zhenhua
I. What is idiopathic dwarfism?
1. refers to an individual whose height is lower than the 3rd percentile or 2nd SD of the same age and sex.
2. normal length and weight at birth.
3. normal levels of growth hormone stimulation tests.
4. for idiopathic short stature include: somatic growth delay, delayed puberty (CDGP), familial short stature.
5. except for those with clear causes: chronic diseases, malnutrition and social and psychological factors, etc., i.e., short stature without any cause is idiopathic short stature
The best time to start treatment for idiopathic dwarfism: International and domestic pediatric endocrinologists suggest that the best age to start treatment for children with dwarfism is from 5 years old to early adolescence, and the earlier the treatment, the better the outcome.
Which children with idiopathic dwarfism need treatment?
1. Growth indicators: If the height is lower than -3 to -2 SDS or below the 3rd percentile for the same age and sex, treatment with GH is recommended.
2. Psychosocial indicators: Doctors generally do not advocate treatment for children and parents who do not mind their height, while children who are obviously troubled by dwarfism should be given medication or psychotherapy. Since it is difficult to quantify psychosocial behavior, the psychological benefits of GH treatment for such children have not been confirmed.
What tests are needed for idiopathic dwarfism?
1. Medical history and physical examination.
(1) Birth history: the presence of intrauterine growth disorders and perinatal complications
(2) Medical history: presence of chronic diseases or related symptoms, medication, nutritional status, psychosocial status and cognitive development
(3) Family history: pay special attention to whether the parents are married by visiting relatives and the age of puberty of the parents, and the height of first- and second-degree relatives.
(4) Physical examination: phenotypic characteristics, somatic proportions and pubertal stages
2. Routine laboratory tests.
Blood and urine routine, liver and kidney function, thyroid function, insulin-like growth factor 1 (IGF-1) level, left wrist bone age X-ray, growth hormone stimulation test to exclude GHD, all short girls of unknown etiology and short boys with external genital abnormalities should be examined for karyotype, cranial MRI to exclude intracranial tumor
D. Treatment goals and ethical principles of treatment for children with dwarfism
1. Principle: The diagnosis and treatment of children with dwarfism should be under the guidance of a pediatric endocrinologist.
2. Objectives of treatment
First: to achieve normal adult height.
Secondly: to reach the standard height of normal children in childhood.
3. Ethical issues of treatment
Since growth hormone is more expensive than ordinary drugs, and children diagnosed with dwarfism and needing treatment are already very short compared to children of the same age, the cost to reach the standard height of normal children is also higher.
In addition, height and efficacy should be monitored regularly during the treatment process, and the treatment plan and the dosage of drugs should be adjusted.
V. Psychosocial status of the child with ISS
Short stature may lead to childish behavior, being treated as a toddler, impaired self-esteem, and frequent bullying. Children with ISS may often feel stressed, but rarely have real psychological problems.