With the development of society and the improvement of national living standards, 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 medical knowledge in this area and are not prepared for the visit, they often fail to arrange the examination reasonably, 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, so here I would like to give some answers to the flow of consultation for children with dwarfism and related issues for parents and children’s reference.
First of all, we will measure the height and weight. When measuring height, please take off 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 proportions, and examination of important organs, and examination of the development of secondary sexual characteristics.
The following are the laboratory tests.
①Blood and urine routine, liver and kidney function, blood glucose;
②Bone age;
③ MRI of pituitary gland (to see the size of the pituitary gland and whether there are occupational lesions);
④Thyroid function, insulin-like growth factor-1, insulin-like growth factor binding protein-3 test;
⑤ Growth hormone stimulation test;
(6) Chromosome examination (if necessary);
(7) Adrenal ultrasound (if necessary), etc.
Then why do these tests?
1.Bone age film: For children with short stature, the first step is to take an X-ray of the left wrist and palm finger (bone age film) to understand the bone age, determine the growth of the child’s bones, the degree of epiphyseal closure (if the epiphysis is closed, no more treatment is possible) and the growth potential, especially through a 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 to 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; if there are abnormalities in liver function, growth hormone should be used with caution or prohibited, because growth hormone has to be metabolized by the liver, which will increase the burden on the liver; abnormal fasting blood sugar should be investigated first or treated first for blood sugar problems.
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 the growth hormone is normal or not, so the growth hormone stimulation test is performed.
What is the growth hormone stimulation test method?
a. The test is performed in the early morning without exercise and on an empty stomach. The night before the test, fasting and water fasting are started, and fasting is done during the whole test.
b. Two kinds of drugs are used in the test (to avoid a 15% false positive rate for one kind of drug): insulin, colistin, arginine, levodopa, etc. Two kinds of drugs are selected, one of which is a growth hormone releasing hormone stimulating drug and the other is a growth hormone releasing hormone inhibiting drug.
c. Route of drug administration: oral and intravenous. The oral and intravenous routes of administration can reduce the possibility of oral drugs acting rapidly due to digestion and absorption.
d. Time and frequency of blood collection for stimulation test: Blood is collected once before drug administration to determine the basal growth hormone value, and 30, 60 and 90 minutes after drug administration to measure the growth hormone value respectively.
e. Judgment of results: GH peak value ≥ 10ng/ml at any one time is normal; GH peak value < 5ng/ml is complete deficiency; 5ng/ml < GH peak value < 10ng/ml is partial deficiency. (Note: complete deficiency is distinguished from partial, not the complete absence of growth hormone in the body)
4.Chromosomes and MRI: Chromosomes should be checked in undeveloped girls to rule out “congenital ovarian hypoplasia (Turner’s 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.