I. Purpose and classification of diagnosing short stature
Human growth and development from the fertilized egg to adulthood is a growth process that is regulated and controlled by a variety of factors. Pediatric growth and development is continuous, but there can be certain characteristic changes at a certain stage, thus forming different developmental stages. The assessment of growth is generally done using three methods: the mean standard deviation method, the percentile method and the median percentage example.
The criteria for diagnosing short stature are more than 2 SD lower than the height of the same ethnicity, age, and sex, a growth rate of 1 SD below the normal rate, and a 0.5 SD reduction in growth rate below 2 years of age (generally referred to as << span="">2 years of age, growth rate of << span="">175 px per year, growth rate of << span="">112.5 px from 4 or 5 years of age to puberty /year, pubertal growth rate less than 150px/year) need to be examined for the cause of short stature.
Second, the diagnosis of dwarfism
1. Medical history: newborns with hypoglycemic episodes, delayed jaundice, history of micropenis,’ history of intracranial irradiation, ƒ history of cranial injury, history of cranial injury or central nervous system infection, history of craniofacial midline abnormalities.
2. Short stature (more than 2 SD lower than the height of the same ethnicity, age and sex), growth rate (generally referred to << span="">2 years old, growth rate << span="">175px per year, growth rate << span="">112.5px/year from 4 or 5 years old to puberty, growth rate below 150px/year at puberty).
3, clinical manifestations: proportional dwarfism, infantile, more plump subcutaneous fat, more facial nevi, some patients may be accompanied by central uveitis (short stature combined with uveitis need to be highly alert to intracranial tumors), but normal intelligence.
Adults show decreased motor ability, reduced social activities, low emotional response, sexual life disorders, and a tendency to retire early.
4.GH stimulation test: It is less meaningful to take serum at any time to determine the concentration of growth hormone because growth hormone is pulsatile growth and its basic value is often low and fluctuates greatly, so it cannot distinguish normal from growth hormone deficiency. The diagnosis of growth hormone deficiency in children requires a growth hormone excitation test. The most commonly used growth hormone excitation tests are insulin hypoglycemic growth hormone excitation test, levodopa growth hormone excitation test and arginine growth hormone excitation test.
Before performing the growth hormone excitation test, we must ensure that the thyroid function and liver function are normal: on the one hand, hypothyroidism itself can cause short stature; on the other hand, the body is less responsive when hypothyroidism is present, so even if the results of the two growth hormone excitation tests cannot be determined, the child cannot be diagnosed with growth hormone deficiency.
If insulin hypoglycemic excitation test is performed, it is likely that the child will have persistent hypoglycemia due to insufficient hepatic glycogen reserve, which is difficult to correct and may be life-threatening in severe cases. Another precaution in performing insulin hypoglycemia excitation test is that if the child has a history of convulsions, other excitation tests are generally chosen to avoid inducing convulsions.
5.Bone age determination: the child’s actual age is less than 2 years younger than normal.
6. Exclude other diseases.
Treatment of dwarfism
Both idiopathic and secondary growth hormone deficiency can be treated with growth hormone. The purpose of growth hormone replacement therapy is to make the patient’s final height reach the normal range as much as possible, so the patient’s target height is often used as an indicator to determine the course of treatment, and the drug is also discontinued when the annual growth rate is less than 62.5 px, or when the epiphysis is basically closed.
Side effects of growth hormone therapy.
1. Local reactions: Local skin reactions (redness, swelling, heat and pain) are seen in some patients.
2. Antibody production: antibody production is closely related to the purity of the preparation.
3. Subclinical hypothyroidism: When treating children with growth hormone deficiency with growth hormone, attention needs to be paid to review thyroid function and, if necessary, adrenal cortical function If a child is diagnosed with growth hormone deficiency and starts treatment with growth hormone, thyroid function needs to be reviewed after 3 months, especially in children with a history of abnormal delivery. As mentioned earlier, these children are at high risk for a combination of underlying secondary hypothyroidism and secondary hypoadrenocorticism.
Before using growth hormone, the child’s thyroid function may still be able to maintain systemic metabolism, but after using growth hormone, the child will increase rapidly and thyroid hormone may not be enough, so thyroid function must be rechecked at this time for further clarification.
4, femoral head shedding necrosis: its incidence can be large 239/100,000 or so, after the application of growth hormone treatment, children with accelerated epiphyseal growth, increased muscle strength, increased movement and weight, can make the iliac joint appear femoral head slippage, aseptic necrosis and lameness.
5.Idiopathic intracranial hypertension: GH can cause sodium and water retention, and individual patients can cause idiopathic intracranial pressure elevation, peripheral edema and blood pressure elevation.
6.Possible to induce tumor: It is pointed out that people with family tendency to develop tumor and tumor patients with secondary GH deficiency, those with unstable disease and hematological abnormalities should apply GH with great caution or not.
7. May accelerate youth development: It may accelerate the speed of youth development, accelerate bone maturation and complete epiphyseal closure earlier.