Tokushukai Medical Group

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Pediatric Diseases: Short Stature

What is short stature? Draw attention at the beginning of exponential growth.

In describing short stature with using statistic indicator, twice or over standard deviation shorter than averaged height. 2.3% of people fall into this category.

Short stature does not mean that they are all in awful disease, since many are in good health other than short height. But like a word of disturbance in growth, child’s short stature might be caused by some kind of disease so that the treatment for that particular disease is necessary. Even though that particular disease can not be cured completely, adequate treatment may improve short stature (disturbance of growth) condition.

Child grow and matured as adult. In fact, mechanism of making body to grow is a complex one. Many “growing factor” (like hormone) works for. Growth hormone is one of them. Sex hormone is also one of growth hormone so that height grows tall in early adolescence, but after certain height growth, it stops growing. Therefore, it is important to pay attention on start growing height is sufficiently tall enough or not, to predict the matured height.

Short stature is not a severe disease, but when child is short height, there might be a case where surrounding social valuation for the child ability is degraded. i.e. People recognize the child as it is quite natural for that child is only able to do the same thing with the younger age child at the same height, thus the child is assumed by him/her-self that is the case. This kind of surrounding reception causes “a feeling of inferiority” (low self-esteem) on the child, and also disturbs the child growth (not only mentally but also ability wise). It is inevitable to correspond with these child with adequate and age-appropriate support.

Causes of short stature are categorized into 3 groups.

It is called as “disturbance of growth” for the child not growing well. To categorize the causes of the disease by whether or not the grow hormone injection may cure the disease, they are as follows;

Other than above, so called “delay of puberty”, there exist the children whose puberty period starts late, at junior high-school or high school. Although they are short stature during elementary school period, they grew taller steadily after puberty period, so that their height is not short stature when getting adults, but it is not necessarily tall enough against the average height.

Make out short stature by “growth curve”

It is relatively difficult to become aware of short stature. A short stature child does not visit hospital until the height is getting shorter than his/her brother or sister. There is a case where parents do not concern about his/her height so much as there are more shorter height child in the same grade classmates. As the parents are shorter in height, they have no choice but left short statured child behind them.

The best way to become aware of short stature is to draw up child height in “growth curve” graph. This chart is listed in maternal handbook, also able to get this from medical check-up conducting school or public health center, or at pediatric in hospital. It becomes clear that how much shorter he/she is, or when does he/she become short stature. It is then recommended to measure not only weight but also heights whenever having health check opportunity.

In case (1) height does not grow due to severe disease, short stature becomes clear with the other symptoms of the disease in most cases.

In hypothyroidism accompanied with autoimmune thyroiditis, called as Hashimoto Disease, height growth becomes extremely small and also obesity trend, inactivity or academic failure can be seen.

In case of brain tumor called as craniopharyngioma, roughly from infant period to school child age growth hormone secretion is getting worse so that height does not taller, and sometimes headache or disturbance of vision may appear.

In (2): Turner syndrome and Achondrogenesis disease case, height is extremely short even in infant period, and even after, the most cases, growth in height is smaller than the average. For Prada-Willi syndrome case, it can be aware since height is small, and muscle is week at infant period, but after obesity trend becomes distinct.

“Growth hormone deficiency” is not a disease which is developed by single cause. It is a named disease for the person to be confirmed, by special examination, as growth hormone has not been secreted well enough. It is therefore, appearance way may differ from the causes of short stature.

In case of the disease hormone does not secrete by nature (hereditary growth hormone secretion deficiency), it is characterized by small in height from infant period, and forehead seems relatively large appearance. Yearly height growth is getting smaller, and short stature becomes gradually apparent.

Examination and diagnosis for short stature.

For (1) and (2) diseases, examination is performed to diagnose the disease.

For hypothyroidism diagnosis is the easy one since thyroid hormone is measured at blood test. For brain tumor, it is diagnosed by head MRI exam, and hormone test in the blood is also necessary. For the bowel, liver or kidney diseases, there is an examination available to test these diseases. To diagnose Turner syndrome, chromosomal test is necessary. For achondrogenesis disease, it is diagnosed by roentgen test for entire bones of the body.

For “growth hormone deficiency”, once blood test to measure growth hormone in a doctor’s office is not sufficient enough for diagnosis. Since growth hormone increases just in a limited time like night sleeping hour, it is quite normal that hormone value is low for the outpatient in the morning hours. Because of this reason, to diagnose growth hormone deficiency, after growth hormone increasing drug is injected or taken, “Stress Test” is conducted in every 30 minutes interval blood draw. When growth hormone does not reach to specific density or over, it is diagnosed as growth hormone deficiency, then growth hormone treatment can be started.

However, as growth hormone secretory response against the drug is strongly affected by the autonomic nerve balance, it is necessary to conduct more than two kinds of stress test.

On the other hand, growth hormone will produce IGF-1 (somatomedin C) hormone in liver, and this hormone has the function of extending the bones. Whether this hormone is produced is able to find out by only one-time blood examination, this is used to judge growth hormone is adequately enough secreted.

Growth hormone is secreted from organ in brain, named as hypophysis, but hypophysis is secreting another hormone. And for example, when hypophysis is damaged by brain tumor or out injury of head itself, secretion of these hormone ae also getting worse. Stress test to check this status then judge the disorder level. If disorder occurred, treatment for each hormone disorder become necessary.

Combine variety treatment methods with a focus on growth hormone injection.

For the disease which growth hormone has the effect in extending the height, growth hormone injection treatment is applied. Growth hormone is normally secreted during night sleep time for healthy people, normally it is injected hypodermically by the set amount every day before sleep.

In case when growth hormone has an effect, treatment is continued for 2 to 3 years, and height growth a year might reach to plus 2cm extension than the past, and some of them might be extended over 10cm annum. This is called as Height Catch Up Phenomenon, and when such period is over, height extension will become the same as healthy people appropriately for age.

or the child who has a disorder in only growth hormone secretion, early adolescence (male hormone or woman hormone starts secreting) may come in sometime. Growth in height during early adolescence are for male approximately 26cm and for woman approximately 20cm. So that it is able to predict adult height by measuring the height at the start of adolescence period.

Appropriate and necessary treatment will be performed for each (1) or (2) disease. Thyroid hormone is taken every day for hypothyroidism. No growth hormone treatment is performed. In case of brain tumor, surgery or radiation therapy are necessary. After these treatments have done, growth hormone treatment may apply after monitoring prognosis for a while and there is no recurrence. Also, as many hormones which is supposed to secrete from hypophysis have become compromised, Hormone treatment other than growth hormone may become necessary.

For kidney, bowel or liver disease, it is important to appropriately treat disease itself, and in case when height growth is insufficient even with conducting appropriate treatment, then growth hormone treatment may apply.

Children, who are suffered with the strong stresses due to harsh living environment, are unable to have height growth because growth hormone secretion is suppressed by autonomic nerve effect. For these, first thing to do is to relieve their stress, and injection of growth hormone is just a supplemental treatment.

For Turner syndrome, treatment with growth hormone only is applied to increase height until the onset of puberty period of healthy people, but another appropriate treatment, like female hormone treatment after puberty period or treatment against the complicating disease, becomes necessary.

For Achondrogenesis disease, not only growth hormone treatment but also treatment for neurological complications caused by bone deformation or bone elongation surgery are considered. For Prada-Willi syndrome, certain devisal is necessary to prevent from adiposity with excessive eating and its complicating disease.