A. What is short stature
There are two types of short stature that people usually refer to.
One is a boy whose height is within the normal range but short, for example, a boy aged 5 weeks is less than 110 cm and more than 103 cm. a boy aged 10 weeks is less than 140 cm and more than 128 cm. They are not tall, but not dwarf.
The second is shorter than average, for example, a 5-week-old boy is less than 102 cm tall and a 10-week-old boy is less than 128 cm tall, which is short in stature, i.e., medically known as dwarfism.
What is dwarfism?
Dwarfism refers to a particularly short stature, for example, a boy of 5 years old is only 85 cm tall, and a boy of 10 years old is only 110 cm tall. Any boy who is unusually short in height, regardless of the cause, is collectively called dwarfism.
What causes short stature?
There are many causes of short stature, and only some of the more common ones can be listed here.
1. Congenital genetic disorders
Many congenital hereditary diseases can cause short stature, the more common ones are as follows.
(1) Congenital chondrodysplasia
These children have short limbs, normal trunk, and disproportionate limbs since birth. Because of the slow growth rate, the gap between these children and children of the same age becomes bigger and bigger, and they show severe dwarfism.
(2) Congenital ovarian hypoplasia
These children are born with normal performance and gradually show slow growth, short stature, no female secondary sex characteristics, and special physical signs.
(3) Low blood phosphorus anti-D rickets
The child is normal at birth and gradually shows symptoms after one week of age, with slow growth and severe “O” shaped legs.
(4) Mucopolysaccharidoses
There are many types of mucopolysaccharidoses, many of which show short stature, but these children have other serious deformities in addition to short stature, and they are born normal, and gradually show symptoms after one week of age.
2. Chronic systemic diseases
Intestinal malabsorption syndrome, hypoxic congenital heart disease, renal dysplasia, etc.
3.Intrauterine growth retardation
Although the children are delivered at full term, they weigh less than 2.5 kg and some are less than 2 kg. They also tend to have slow growth and short stature after birth.
4.Familial dwarfism
The parents of the children are short and the short stature of these children is usually not serious, they are born normal and well-proportioned.
5.Nutritional deficiency dwarfism
The growth is slow due to insufficient nutritional intake for a longer period of time, and the growth will be accelerated if sufficient nutritional intake and reasonable diet structure are restored in time.
6.Psychological dwarfism
Due to the poor living environment, the child’s mental and psychological frustration, resulting in slow growth. As long as the unfavorable factors in the original living environment can be eliminated in time, significant height growth will occur after several months.
7.Physical growth delay
They have delayed puberty development and accelerated height growth until the puberty development period, with normal adult lifetime height.
8.Endocrine abnormalities
The following are common.
(1) Hypothyroidism
There are two types of children with hypothyroidism.
The first is hypothyroidism at birth, if left untreated, they will be short and stupid, commonly known as “cretinism”, and the second is hypothyroidism in childhood, with normal intelligence, mainly because they are short and easily missed. Thyroxine is very cheap and effective, but the key is early diagnosis.
(2) Growth hormone deficiency (pituitary dwarfism)
It is caused by a lack or deficiency of growth hormone produced by the pituitary gland (located at the base of the brain).
Pituitary dwarf caused by growth hormone deficiency is normal at birth, growth slows down after five months of life, and the slow growth increases with age.
(3) Precocious puberty (introduced in a separate article)
IV. How to read the growth hormone test lab sheet and what should be noted in diagnosing growth hormone deficiency.
Some children with short stature need to have growth hormone check. Growth hormone is produced by the pituitary gland located at the base of the brain, then secreted into the blood, and then through a complex physiological process, it acts on the bones to make children in the growth period grow taller. Growth hormone is produced and secreted in waves, sometimes high and sometimes low, so the pituitary gland is stimulated with medication and blood is drawn every half hour after the medication is administered, usually 3 to 4 times. Since one drug stimulation sometimes does not reflect the true level of growth hormone, two drug stimulation tests are performed. If the highest value of one of the two drug stimulation tests is greater than 10ng/ml, it is considered normal, less than 5ng/ml is considered complete growth hormone deficiency, and greater than 5ng/ml and less than 10ng/ml is considered partial growth hormone deficiency. Since the test results are influenced by many factors, it must be combined with the child’s clinical condition, such as the degree of short height, the degree of bone age lag, growth and development, etc. for a comprehensive analysis.
V. What kind of short stature can growth hormone treat and how effective is it?
Nowadays, the growth hormone used in medicine is produced by bioengineering methods. Its structure and function are similar to the growth hormone produced by the pituitary gland, so when the pituitary gland cannot produce enough growth hormone for human skeletal growth, it can replace and supplement it to help the affected children grow normally.
Various causes of short stature have been described above, but the real short stature caused by growth hormone deficiency is mainly pituitary dwarf, therefore, pituitary dwarf caused by growth hormone deficiency is the main target of growth hormone treatment. Most of the children with this condition have a good treatment effect. The growth rate is relatively fast in the early stage of treatment, which can grow more than 1 cm per month, and slower later. After enough time of continuous treatment (usually 5~6 years), the adult lifetime height of normal people can be reached.
Since there is no better treatment for many dwarfism, growth hormone is now also used for the treatment of some other short stature. However, most of them are not as effective as pituitary dwarf.
What to pay attention to when treating with growth hormone
Growth hormone is a relatively expensive drug, and the current method of using the drug is still subcutaneous injection once a day. There are many reasons for short stature, and not all short stature can grow taller with growth hormone, therefore, a strict examination should be made before the growth hormone is administered.
For those children who are young and shorter, but not very short, you can observe them for a period of time to see how fast they grow. Adjust sleep, nutrition and exercise (adequate sleep, reasonable nutrition, sufficient exercise); prevent diseases, such as repeated respiratory infections and diarrhea; if the child’s growth rate accelerates to more than 5 cm per year, you can wait for some time before making a decision.