Related Experiment Videos
[Growth disorders. Recommendations for a practice-oriented classification]
1Abteilung I, Universität Ulm.
Insights
Pediatric growth disturbances are common, requiring thorough history and measurements. Many postnatal growth disorders, including hormone deficiencies, are treatable, improving children's health outcomes.
Area of Science:
- Pediatric Endocrinology
- Child Growth and Development
- Medical Diagnostics
Context:
- Growth disturbances are frequent reasons for pediatric consultations, alongside acute illnesses.
- Accurate diagnosis relies on detailed family and personal history, parental measurements for target height calculation, and growth charting on percentile curves.
- Hormone levels and bone age determination via X-ray are secondary diagnostic steps.
Purpose:
- To outline the diagnostic approach for pediatric growth disturbances.
- To differentiate between normal growth variants and pathological processes (proportionate vs. disproportionate).
- To identify treatable postnatal growth disorders and their therapeutic strategies.
Summary:
- Growth aberrations are classified as normal variants or pathological processes, with the latter potentially causing proportionate or disproportionate disturbances.
- Postnatal growth disorders amenable to therapy include isolated growth hormone deficiency, congenital adrenal hyperplasia, precocious puberty, and hypothyroidism.
- Treatment efficacy varies; hormone replacement is effective for specific endocrinopathies, while estrogen/gestagen therapy for tall stature shows limited results.
Impact:
- Effective treatment of primary diseases can improve secondary growth disturbances.
- Timely diagnosis and intervention can significantly improve outcomes for children with treatable growth disorders.
- Understanding the timing (pre- or postnatal onset) of growth deviation is crucial for therapeutic planning.
Abstract:
Besides acute illnesses, including allergies, growth disturbances are among the most frequent reasons for parents to consult a physician about their children. The basis of diagnosis is a detailed family and personal history. Actual measurement of the parents is necessary for calculation of the patient's target height. The growth data obtained must be charted on percentile curves. Only in the second line of the diagnostic approach should the physician resort to hormone determinations and X-rays of the left hand and wrist for bone age determination. For practical purposes, growth aberrations may be subdivided into normal variants and pathologic processes. The latter may cause proportionate or disproportionate disturbances. For therapeutic reasons it is also important to know whether the deviation of growth started pre- or postnatally. Many growth disorders that develop postnatally are amenable to therapy. They include the following endocrinopathies associated with short stature: isolated growth hormone deficiency (treatment with hGH), congenital adrenal hyperplasia due to enzyme deficiencies (treatment by replacement of cortisol), idiopathic, iso-sexual precocious puberty (treatment with LHRH agonists), and hypothyroidism (treatment with thyroxine). Patients with Turner syndrome benefit from sex hormones only insofar as secondary sexual characteristics develop: these agents do not promote overall growth. The treatment of patients with tall stature by administration of estrogens/gestagens in high dosages is viewed with increasing scepticism. On the average, only a 4-cm reduction in length can be achieved if patients are treated from the onset of puberty through a bone age of 16 years. All secondary growth disturbances are improved by efficient treatment of the primary, underlying disease entity.