Short Stature In Children Research Articles

Characteristics and etiologies of short stature in children: Experience of an endocrine clinic in a Tunisian tertiary care hospital.

BackgroundShort stature is a common reason for referral to pediatric endocrinology clinics. It may be a manifestation of a pathological condition requiring early treatment. The aim of this study was to describe the characteristics and etiologies of short stature among children referred to the pediatric endocrinology clinic of the main pediatric tertiary care center in Tunisia.MethodsRetrospective and descriptive study in the endocrinology unit of children referred for short stature between January 2012 and December 2016. Data on the patients' medical history, physical findings, laboratory tests, bone age and chromosomal analysis were collected.Results470 children (266 males and 204 females) were referred during that period. 214 (45.5%) had normal height, and 80.8% of them were referred by general practitioners. The other 256 children (54.5%) had a confirmed short stature (mean age :7.2 years, mean height: -2.77 SDS). Endocrinological causes were the most common(43% GHD, 4% hypothyroidism) followed by intrauterine growth retardation IUGR (24%), genetic syndromes (8.4%), chronic pediatric diseases (7.8%), skeletal dysplasia (6.2%), normal variant of short stature (5%), and psychosocial deprivation (1.2%). Among non-endocrine causes, Turner syndrome was the most common genetic syndrome (4.4%), achondroplasia the main skeletal dysplasia (4%) and celiac disease the main chronic disease (3.4%).ConclusionsST is largely overestimated in our country. Therefore, it is important to insist on adequate measurement and analysis of growth parameters to avoid unnecessary investigations. GHD and IUGR were the most common causes. Celiac disease, though frequent in Tunisia, is not a common cause of short stature.

Status Gizi Dan Karakteristik Orang Tua Pada Siswa Dengan Perawakan Pendek di SD Negri 065853 Medan

Abstrak: Sustainable Development Goals (SDGs) pada tujuan nomor dua (zero hunger) menargetkan pada tahun 2030 mengakhiri segala bentuk malnutrisi. Di Indonesia sendiri masalah gizi masih menjadi masalah kesehatan masyarakat dan status gizi merupakan salah satu indikator kesehatan. Pada anak usia sekolah diperlukan pemenuhan zat gizi tidak hanya untuk menjamin pertumbuhan dan perkembangan anak tetapi juga untuk mengoptimalkan fisik, mental dan sosialnya sehingga mampu menjadi generasi yang produktif. Ketidakseimbangan gizi dapat menurunkan kualitas Sumber Daya Manusia (SDM) yang pada akhirnya akan menghambat pembangunan nasional. Tujuan penelitian ini adalah untuk mengetahui gambaran status gizi dan distribusi karakteristik orang tua pada siswa dengan perawakan pendek. Penelitian ini menggunakan desain cross sectional study. Sampel penelitian adalah siswa SD negri 065853 Medan sebanyak 77 orang .Jumlah tersebut ditentukan menggunakan rumus besar sample proporsi untuk satu sampel populasi presisi dan menggunakan teknik proportional stratified random sampling dalam pemilihan sampel. Data status gizi dan karakteristik orangtua didapatkan melalui pengukuran antropometri dan kuesioner. Data yang terkumpul kemudian dianalisis secara univariat.Hasil penelitian didapati status gizi terbanyak pada kategori underweight dan perawakan terbanyak pada kategori normal. Untuk distribusi pada anak perawakan pendek didapati status gizi terbanyak dalam kategori underweight. Distribusi anak perawakan pendek menurut karakteristik orang tua didapati pendidikan ibu terbanyak pada kategori menengah, pengetahuan ibu terbanyak pada kategori baik dan pendapatan orang tua terbanyak pada kategori rendah

A review of growth hormone deficiency

Abstract Growth hormone deficiency (GHD) is a rare but important cause of short stature in children. It is treatable. However, diagnosis is challenging and often requires referral to a specialist paediatric endocrinologist to facilitate testing and the interpretation of results. Careful history and examination with meticulous auxology data are critical components of the initial evaluation in clinic. Thereafter, further investigations are required to exclude other causes of short stature, and to establish the diagnosis. It is a highly variable condition and to an extent the clinical features depend upon the severity of GHD itself. GH stimulation tests may be indicated in the short child who is growing slowly and who has low growth factor concentrations. There is, however, no consensus with respect to a diagnostic gold standard test for GHD, and this is usually based upon a combination of clinical, biochemical, and neuroradiological data, although molecular diagnosis may aid in years to come. This short article gives an overview of the importance of GHD and offers advice on how to take a history, conduct and examination and begin investigation for a child with suspected GHD. It discusses the known benefits and potential risks of treatment and offers practical advice for the generalist.

Low-density lipoprotein cholesterol levels are associated with insulin-like growth factor-1 in short-stature children and adolescents: a cross-sectional study

BackgroundElevated low-density lipoprotein cholesterol (LDL-C) levels in childhood have recently been found to be the strongest predictive risk factor for coronary artery disease in adulthood. There is an increased level of LDL-C in children and adolescents with short stature. However, the underlying factors associated with increased LDL-C levels in children and adolescents with short stature are unknown. In addition, the insulin-like growth factor 1 (IGF-1) level in the short-stature population is usually below the normal reference range. The aim of this study was to investigate the relationship between IGF-1 standard deviation score (IGF-1 SDS) and LDL-C level in children and adolescents with short stature.MethodsA cross-sectional study was conducted in a single centre of China, 557 short-stature children and adolescents whose height SDS was lower than − 2 SD after adjustment for age and gender were included. The related clinical and laboratory examinations, including anthropometric parameters, lipid profiles, IGF-1 levels and the levels of other cofactors, were assessed in all participants.ResultsThe univariate analysis results showed a significant negative correlation between IGF-1 SDS and LDL-C levels (P = 0.006). Furthermore, a nonlinear relationship was observed between IGF-1 SDS and LDL-C by smooth curve fitting after adjusting for possible confounders. A multivariate piecewise linear regression model revealed a significant negative correlation between IGF-1 SDS and LDL-C when the IGF-1 level was greater than − 2 SDS (β − 0.07, 95% CI -0.12, − 0.02; P = 0.006). However, we did not observe a significant relationship between IGF-1 SDS and LDL-C when the IGF-1 level was lower than − 2 SDS (β 0.08, 95% CI -0.02, 0.17; P = 0.119).ConclusionThis study demonstrated a nonlinear relationship between IGF-1 and LDL-C independent of other potential confounding factors, suggesting that circulating IGF-1 may contribute to the regulation of LDL-C levels, thus meriting further investigation.

Biochemical parameters during growth hormone therapy in short-stature children exhibiting common polymorphisms of growth hormone receptor

Biochemical parameters during growth hormone therapy in short-stature children exhibiting common polymorphisms of growth hormone receptor

Respiratory chain inactivation links cartilage-mediated growth retardation to mitochondrial diseases.

In childhood, skeletal growth is driven by transient expansion of cartilage in the growth plate. The common belief is that energy production in this hypoxic tissue mainly relies on anaerobic glycolysis and not on mitochondrial respiratory chain (RC) activity. However, children with mitochondrial diseases causing RC dysfunction often present with short stature, which indicates that RC activity may be essential for cartilage-mediated skeletal growth. To elucidate the role of the mitochondrial RC in cartilage growth and pathology, we generated mice with impaired RC function in cartilage. These mice develop normally until birth, but their later growth is retarded. A detailed molecular analysis revealed that metabolic signaling and extracellular matrix formation is disturbed and induces cell death at the cartilage-bone junction to cause a chondrodysplasia-like phenotype. Hence, the results demonstrate the overall importance of the metabolic switch from fetal glycolysis to postnatal RC activation in growth plate cartilage and explain why RC dysfunction can cause short stature in children with mitochondrial diseases.

GnRHa/LHRHa are Effective Against Short Stature in Children with Normal Puberty: A Systematic Review and Meta-Analysis

Objectives: We aimed to test the hypothesis that gonadotrophin-releasing hormone agonists (GnRHa) or luteinizing hormone releasing hormone agonists (LHRHa) can increase height gain of short children with normal puberty via a comprehensive meta-analysis on clinical controlled trials. Methods: Literature search was conducted before March 25, 2019. Data extraction and quality assessment were independently completed by two authors. Effect-size estimates are expressed as weighted mean difference (WMD) and 95% confidence interval (95% CI). Results: Five randomized controlled trials and 4 non-randomized controlled trials involving total 340 short children with normal puberty were eligible for analysis. Overall, GnRHa/LHRHa administration resulted in significant gains in height standard deviation score (SDS) (WMD: 0.60 and 0.77 relative to initial height SDS and predicted height SDS; 95% CI: 0.26 to 0.94 and 0.27 to 1.27; p =0.001 and 0.003, respectively) and height (WMD: 4.52 cm and 6.0 cm relative to initial height and predicted adult height; 95% CI: 2.83 to 6.21 and 4.48 to 7.52; p <0.001 and <0.001, respectively), with significant heterogeneity observed for two height SDS comparisons, and effect-size estimates were more obvious when combined with growth hormone. There was a low probability of publication bias for above comparisons, as indicated by Egger's tests. Subgroup and meta-regression analyses revealed that intervention interval, treatment regimen and percentage of boys were potential sources of between-trial heterogeneity. Conclusions: Our meta-analytical findings indicate that GnRHa/LHRHa are effective against short stature in children with normal puberty, especially in combination with growth hormone. Funding Statement: The authors state that they received no financial support for this work. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The authors conducted this meta-analysis of clinical controlled trials in accordance with the standards set forth by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.

SAT-257 Clinical, Histochemical, and Molecular Study of Three Turkish Siblings Diagnosed with H Syndrome, and Literature Review

Background: The term ‘H syndrome’ was coined to denote the major clinical findings, which include hyperpigmentation, hypertrichosis, hearing loss, hepatosplenomegaly, hyperglycaemia, hypogonadism, hallux flexion contractures, and short height. Objectives: To report the clinical, endocrinological, histochemical, and genetic findings of three siblings. Methods: Skin and liver biopsies were taken to investigate the histochemical characteristics of hyperpigmented hypertrichotic skin lesions and massive hepatomegaly. The levels of basal serum thyroid hormones, oestradiol, total testosterone, follicle-stimulating hormone, luteinising hormone, and stimulated growth hormone, were measured to investigate the endocrine aspects of the syndrome. Mutation analysis was carried out in all six exons and exon-intron boundaries of SLC29A3 by direct sequencing. Results: Physical examination of the patients revealed common characteristic findings of H syndrome. Additional clinical findings were sectorial iris atrophy in the younger sister and primary amenorrhoea in the older sister. Laboratory evaluation revealed microcytic anaemia, markedly increased erythrocyte sedimentation rate and C-reactive protein levels, and humoral immune deficiency in the younger siblings, who presented with recurrent fever and sinopulmonary infection. Two different growth hormone stimulation tests revealed growth hormone deficiency in the younger sister with short stature. Liver and skin biopsies revealed polyclonal lymphohistiocytic and plasma cell infiltration. Sequencing of SLC29A3 in the three siblings revealed a novel homozygous mutation in exon 6, which caused the transition of arginine to tryptophan. Conclusions: This study not only extended the clinical and mutation spectrum of SLC29A3 in H syndrome, but also showed that short children should be assessed according to the guidelines for short stature in children.

OR17-3 Cartilage-Targeted IGF-1 Treatment to Promote Longitudinal Bone Growth

Recombinant human growth hormone (GH) is commonly used to treat short stature in children. However, GH treatment has limited efficacy particularly in severe, non-GH deficient conditions such as chondrodysplasias, and has potential off-target effects. Because short stature results from decreased growth plate chondrogenesis, we previously developed a cartilage-targeting single-chain human antibody fragment (CaAb) (1), aiming to deliver therapeutic molecules to the growth plate, thereby increasing treatment efficacy while minimizing adverse effects on other tissues. In the current study, we created fusion proteins of these CaAbs conjugated with insulin-like growth factor-I (IGF-1), an endocrine/paracrine factor which positively regulates chondrogenesis. We first used ELISA to assess the ability of the CaAb-IGF1 fusion proteins to bind tissue lysates from different mouse organs and found that the fusion proteins bound to cartilage with high tissue specificity. We also found that these fusion proteins retain potent IGF-1 biological activity, as demonstrated by their ability to stimulate AKT and ERK phosphorylation in cell culture and stimulate metatarsal bone growth in organ culture. To assess in vivo efficacy, we administered daily subcutaneous injections to growth hormone-deficient (lit) mice for 5 days. In this model, twice-daily IGF-1 increased growth plate height but daily IGF-1 did not. In contrast, daily equimolar injections of the targeted fusion proteins did increase growth plate height whereas a fusion protein lacking the cartilage-targeting domain did not (P<0.01 targeted vs non-targeted or saline). Even alternate-day injections of the targeted fusion proteins were sufficient to produce a therapeutic effect (P<0.01) similar to daily injection. To assess off-target effects, we measured proliferation in kidney cortical cells by BrdU incorporation. Daily injections of the targeted fusion proteins did not increase kidney cell proliferation whereas twice-daily IGF-1 itself (the minimum IGF-1 regimen that stimulated the growth plate) did stimulate kidney proliferation (P<0.01). In summary, the fusion proteins, unlike IGF-I itself, were able to stimulate growth plate activity without significant off-target effects on kidney. Our findings therefore provide proof-of-principle that targeting therapeutics to growth plate cartilage can potentially improve treatment for childhood growth disorders. Reference: (1) Cheung et al. Pharma Res 2015 Jul;32(7):2439-49. Sources of Funding: This work was supported by the Intramural Research Programs of NICHD and NCI, National Institutes of Health. Additional funding through Grant for Growth Innovation from EMD Serono, Inc. a biopharmaceutical business of Merck KGaA, Germany, and Endocrine Scholars Award in Growth Hormone Research from the Endocrine Society.

SUN-252 Comparison of Sitting Height/Height Ratio for Age in Children with Short Stature Caused by Defects in Growth Plate Genes

Introduction: Abnormal body proportion disclosed by sitting height/height ratio for age and sex (SH/H SDS) > 2 indicates an impairment of appendicular growth. This is frequently observed in patients with skeletal dysplasia and can be the only clinical sign in nonsyndromic short stature children that harbor heterozygous defects in genes expressed in growth plate. The aim of the present study is to compare the degree of body disproportion among children with different genetic cause of growth impairment. Methods: We evaluated 75 children with short stature caused by defects in known growth plate genes, including FGFR3 gene (16 mutations in 7 patients with achondroplasia - ACH and in 9 patients with hypochondroplasia - HCH), SHOX gene (35 defects in 15 patients with Leri-weill dyschondrosteosis - DLW and in 20 patients with isolated short stature, defined as absence of Madelung deformity clinically and radiologically), NPR2 gene (8 heterozygous mutations) and IHH gene (16 heterozygous mutations). Variants in NPR2 and IHH genes were identified in children with isolated short stature or with nonspecific skeletal abnormalities. Results: At first evaluation, patients had a mean age of 8.7±4.9 years. Children with ACH were significantly shorter than those of the other groups (mean height SDS: -4.4 vs -2.5, p<0.05). All patients with clinically recognizable skeletal dysplasia (ACH, HCH and DLW) had abnormal body proportion (SH/H SDS >2). The frequency of abnormal body proportion observed in children initially classified as idiopathic short stature (ISS) was 85% for SHOX defects and 56% for IHH mutations (p = 0.073). None children with heterozygous mutations in NPR2 presented abnormal body proportion, though 62.5% had SH/H SDS >1. Children with ACH had SH/H SDS higher than all other groups (mean: 9.9±2.8; p<0.001). The degree of abnormal body proportion observed in children with HCH was similar to that of DLW (mean: 5.7±1.1 and 4.6±2.3, respectively; p = 0.14) and was higher than in children with isolated short stature, independently of the genetic defect (p=0.003 for SHOX and p<0.001 for IHH and NPR2). The mean SH/H SDS observed in children initially classified as ISS was similar between SHOX and IHH groups (mean: 2.9 ± 0.9 and 2.3 ± 1.4, respectively; p = 0.26), which was significantly higher in comparison to NPR2 group (mean: 0.7 ± 1.3; p = 0.004 for SHOX and p=0.024 for IHH). Conclusion: All patients with ACH, HCH and DLW had abnormal body proportion and their SH/H SDS were significantly higher than that observed in ISS children with SHOX, IHH or NPR2 defects. Furthermore, among nonsyndromic children with short stature, abnormal body proportion is associated with SHOX and IHH defects, but not with NPR2 defects. The authors have nothing to disclose.

Metabolomic analysis reveals metabolic characteristics of children with short stature caused by growth hormone deficiency.

The diagnosis of short stature (SS) is of widespread importance for later treatment. In the present paper, a metabolomic method was used to analyze the metabolic characteristics of SS children caused by endocrine metabolic diseases in order to understand the underlying biochemical mechanism and provide a potential intervention strategy for SS. According to the clinical diagnosis and family investigation, all patients with SS were confirmed to be due to the endocrine disorders, especially GH deficiency (GHD). A nuclear magnetic resonance (NMR)-based metabolomic analysis of serum was used to identify the metabolic changes in 45 SS children from the 35 healthy controls (HCs). The disturbed metabolic network related to SS was correspondingly derived from the differential metabolites. The SS children demonstrated higher serum levels of citrate, phenylalanine, creatinine, and tyrosine and lower serum levels of glucose, serine, betaine, inositol, lysine, glycerol, and glutamine compared with the HCs. The results demonstrated that the disturbed glucose metabolism and metabolism and biosynthesis of amino acids are typical metabolic features of SS, and the lower levels of lysine and glutamine are the metabolic characterization of the affected growth axes and stress state of SS, respectively. The significant changes of those serum metabolites are able to be regarded as potential biomarkers for the diagnosis of SS. Accordingly, supplemental betaine in dietary pattern, the improvement of glycometabolism, and endogenous replenishment of lysine and glutamine allow the possible treatment strategy for SS.

Imaging in Short Stature and Bone Age Estimation.

Short stature in children is a diagnostic challenge to the physician. Bone age assessment can be done using various methods. The causes of short stature are variable; often leading to a series of investigations. The endocrine conditions have typical imaging features. This chapter provides a short overview of the methods of bone age estimation, and imaging findings and algorithmic approach towards a child with short stature.

First-year predictors of health-related quality of life changes in short-statured children treated with human growth hormone.

Little attention has been directed towards examining the impact of predictors on change in health-related quality of life (HRQOL) within the course of growth hormone (GH) treatment in pediatric short stature. We aimed to assess changes in HRQOL and its sociodemographic, clinical and psychosocial predictors in children and adolescents diagnosed with growth hormone deficiency (GHD), and born short for gestational age (SGA) before and 12-month after start of GH treatment from the parents' perspective. Results were compared with an untreated group with idiopathic short stature (ISS). In this prospective multicenter study, 152 parents of children/adolescents (aged 4-18years) provided data on their children's HRQOL at baseline and at 12-month follow-up. Repeated-measures multivariate analyses of covariance were performed to examine parent-reported HRQOL changes from baseline to 1-year after treatment and hierarchical linear regressions to identify the predictors of HRQOL changes. Results showed that parents of children that were treated with GH report an increase in their children's HRQOL after 1year. Changes in HRQOL were mostly explained by psychosocial predictors followed by sociodemographic and clinical variables. Specifically, the diagnosis SGA significantly predicted a greater increase in parent-reported HRQOL. Furthermore, a lower caregiving burden significantly predicted a decrease in parent-reported HRQOL. In conclusion, a substantial percentage of explained variance in HRQOL relates to psychosocial and sociodemographic predictors. However, there appears to be other important factors that are predictors of HRQOL, which need to be determined in large, population-based samples.

Upper and Lower Body Segment Ratios from Birth to 18 years in Children from Western Maharashtra.

To assess the upper body segment (US), lower body segment (LS) and US:LS ratio for children from birth to 18 y of age and to compare these data with other US:LS ratio norms from previously reported studies. A cross-sectional, observational study was conducted in children [birth to 18 y; n = 5454 children (3158 boys)] residing in Pune city, Western India, from December 2015 through June 2017, to evaluate the US, LS and the US:LS ratio. The mean US:LS ratio in boys at birth was 1.45; at one year of age it was 1.35 that decreased to 0.89 at 14 y. The nadir for the US:LS ratio in boys was reached at 14 y of age (0.89). In girls, the mean US:LS ratio at birth was 1.44, at one year of age it was 1.35 that decreased to 0.89 at 12 y. The nadir for the US:LS ratio in girls was reached at 12 y of age (0.89). From 12 to 18 y the US:LS ratio was fairly constant (for girls: 0.89, for boys: 0.9). On plotting the US and LS against the age in present study population, the US and LS curves crossed each other (US:LS = 1) at 7 to 8 y in boys and at 6 to 7 y in girls. The authors describe data for upper and lower body segments and their ratio in boys and girls from birth to 18 y in children from western Maharashtra. These data may help in the diagnosis of disproportionate short stature in children.

Cartilage-Targeted IGF-1 Treatment to Promote Longitudinal Bone Growth.

Recombinant human growth hormone (GH) is commonly used to treat short stature in children. However, GH treatment has limited efficacy, particularly in severe, non-GH-deficient conditions such as chondrodysplasias, and potential off-target effects. Because short stature results from decreased growth plate chondrogenesis, we developed a cartilage-targeting single-chain human antibody fragment (CaAb) aiming to deliver therapeutic molecules to the growth plate, thereby increasing treatment efficacy while minimizing adverse effects on other tissues. To this end, we created fusion proteins of these CaAbs conjugated with insulin-like growth factor 1 (IGF-1), an endocrine and/or paracrine factor that positively regulates chondrogenesis. These CaAb-IGF-1 fusion proteins retained both cartilage binding and IGF-1 biological activity, and they were able to stimulate bone growth in an organ culture system. Using a GH-deficient (lit) mouse model, we found that subcutaneous injections of these CaAb-IGF-1 fusion proteins increased overall growth plate height without increasing proliferation in kidney cortical cells, suggesting on-target efficacy at the growth plate and less off-target effect on the kidney than IGF-1 alone. Alternate-day injections of these fusion proteins, unlike IGF-1 alone, were sufficient to produce a therapeutic effect. Our findings provide proof of principle that targeting therapeutics to growth plate cartilage can potentially improve treatment for childhood growth disorders.

Genetic causes of isolated short stature.

Short stature is a common feature, and frequently remains without a specific diagnosis after conventional clinical and laboratorial evaluation. Longitudinal growth is mainly determined by genetic factors, and hundreds of common variants have been associated to height variability among healthy individuals. Although isolated short stature may be caused by the combination of variants, with a deleterious impact on the growth of individuals with polygenic inheritance, recent studies have pointed out some monogenic defects as the cause of the growth disorder observed in nonsyndromic children. The majority of these defects are in genes related to the growth plate cartilage and in the growth hormone (GH) - insulin-like growth factor 1 (IGF-1) axis. Affected patients usually present the mildest spectrum of some forms of skeletal dysplasia, or subtle abnormalities of laboratory tests, suggesting hormonal resistance or insensibility. The lack of specific characteristics, however, does not allow formulation of a definitive diagnosis without the use of broad genetic studies. Thus, molecular genetic studies including panels of genes or exome analysis will become essential in investigating and identifying the causes of isolated short stature in children, with a crucial impact on treatment and follow-up.

Improved General and Height-Specific Quality of Life in Children With Short Stature After 1 Year on Growth Hormone.

Short stature in children and adolescents may lead to social and emotional stress, with negative effects on quality of life (QoL). GH treatment may improve QoL through height normalization. Our objective here was to evaluate general and height-specific QoL after 1 year of GH treatment. Prospective, single-center, observational cohort study. Children ≥ 4 years of age starting GH at our center from 2012 to 2015 to treat short stature were studied. Patients with serious diseases, syndromic short stature, or developmental delay were excluded. At treatment initiation and 1 year later, patients and their parents completed the general PedsQL 4.0 and height-specific Quality of Life in Short Stature Youth (QoLiSSY) questionnaires. Correlations between self-report and parent-report scores and between height gain and QoL improvements were assessed based on Pearson correlation coefficients. Seventy-four children (42 boys, 32 girls), median age (± SD), 10.2 ± 3.0 years (range, 4.1 to 16.6 years), were included. The self-report PedsQL indicated significant improvements in emotional (P = 0.02) and social (P = 0.03) QoL. As assessed by the QoLiSSY, children reported improvement of social QoL (+0.2 SD; P = 0.04), and parents reported improvement of children's physical (+0.1 SD; P < 0.0001), emotional (+0.3 SD; P < 0.0001), and social (+0.3 SD; P < 0.0001) QoL. Height SD score (SDS) gains showed moderate positive correlations with QoLISSY self-report score gains (R = 0.53, R2 = 0.28; P < 0.001) and QoLISSY parent-report gains (R = 0.60, R2 = 0.41; P < 0.00001). After 1 year of GH treatment, children had significant gains in emotional and social QoL, as assessed by a general self-report questionnaire and height-specific parent-report questionnaire.

Evaluation of the etiology of severe short stature in children at a tertiary pediatric endocrinology centre

Evaluation of the etiology of severe short stature in children at a tertiary pediatric endocrinology centre

Heightened Expectations: The Rise of the Human Growth Hormone Industry in America by Aimee Medeiros

Reviewed by: Heightened Expectations: The Rise of the Human Growth Hormone Industry in America by Aimee Medeiros Howard I. Kushner Aimee Medeiros. Heightened Expectations: The Rise of the Human Growth Hormone Industry in America. Nexus. Tuscaloosa: University of Alabama Press, 2018. xii + 195 pp. Ill. $39.95 (978–0–8173–1910–6). Aimee Medeiros has produced a nuanced and persuasive examination of the origins and evolution of human growth hormone industry in America. Its wider implications for historians of medicine, especially those examining the role of the pharmaceutical industry, are profound. Medeiros shows that the attitudes and interventions toward short stature in boys predated the pharmaceutical interest and development of human growth hormones. Only decades later would the pharmaceutical industry add its voice to the health effects of short stature. Medeiros makes a persuasive case that stigmatization of short stature among boys had its origins long before the application of growth hormone therapy. It was not, she demonstrates, driven by the pharmaceutical industry. The book has three main “themes.” First, as discussed above, “the pharmaceutical companies cannot be considered the sole culprits in framing short stature as a disease” (p. 3). Rather she points to the role of the development of the rise of pediatric specialty and its growing reliance surveys and height charts as “diagnostic tools” which set “standards” for “normal” child growth and development. A second theme focuses on the “origins of growth hormone therapy in the United States, and in doing so resets the beginning of the GH (growth hormone) industry to the early twentieth century” (p. 3). Here Medeiros examines the period preceding the reliance on cadaver-based human growth hormone and traces the history its ineffective application and the substitution in the 1950s of the male sex hormone, testosterone. [End Page 137] Her third theme “focuses on how, in the twentieth century, changing sociological notions about gender and masculinity influenced the development of medical treatment of children with short stature” (p. 4). For Medeiros “the history of the rise of the human growth hormone industry is a poignant example of the creation of a ‘desire machine,’ demonstrating how anxieties processes of production, and desires get grafted on to one another” (p. 5). Drawing on the work of Georges Canguilhem, she revisits scientific notions of what constitutes the normal and the pathological, as well as more recent work on what constitutes disability. A wide range of scholarship informs this study, “including the history of hormones, feminist scholarship on gender in medicine, men’s studies on hegemonic masculinity, and disability studies” (p. 9). Medeiros draws on a wide variety of popular sources including film, photography, and popular music. She uncovers the roots of these policies and attitudes in such diverse places as Barnum and Bailey Circus and in the munchkins of L. Frank Baum’s, Wizard of Oz film, and the seven “dwarfs” in the Disney film Snow White. Its late nineteenth- and early twentieth-century origins can be traced to the Progressive concerns with the health effects of child labor. She provides elaborate discussion of the progressive photographer, Lewis Hine to illustrate that short stature among boys was used as evidence of the harmful effects of child labor. Nevertheless, in these early years interventions were ineffective, despite the ubiquity of school height charts which established “normal” versus “abnormal.” Medeiros examines how changes in attitudes toward gender and normality affected attitudes toward short stature. Only later would the development of human hormone interventions insert itself in these long-held attitudes and practices. This is the historical perspective in which Medeiros examines the rise of what would become a billion-dollar industry that reinforced the messages of the need to intervene against what was labelled as short stature, and, more widely, as a threat to the health and development of short stature children. In a series of chapters she examines the evolution of short stature as a problem as an issue of masculinity, the medicalization of midgets, the early and unfulfilled promise of growth hormone, news coverage of GH, and how this failure impacted those with short stature. With a medical diagnosis, but without an effective treatment, those of short stature continued to be stigmatized. Medeiros examines the...

Comparative Analysis of Vitamin D and Minerals in Normal Children and Children with Short Stature of Busan community child welfare center

Purpose The vitamin D and zinc is important micronutrients but are frequently found deficient in the growth of children in their infancy and adolescence. The present study intend for the analysis of nutritional states and health promotion of short stature children in community child welfare center through an identification of correct measurements of zinc and vitamin D from health examination to be conducted. Methods The children, belonging to the range less than 5 percentiles of anthropometrical height, were diagnosed as short stature children based on the children growth curve in the health examination of community child welfare center. A total of 63 children, who took health examination during from March 2017 to February 2018, were selected as subjects of the present study. The subjects were then distinguished between the short stature group and control group. Measurements of bone age, zinc and vitamin D, obtained from nondominant hand x-ray and peripheral blood collection, were examined and compared to analyze effects of the degree of important minerals over short stature children. Results The mean values of the level of measurements of zinc and vitamin D between subjects belonged to the short stature group and control group manifested no significant differences from each other. The difference in the growth parameter corresponded to the severity of blood serum 25(OH)D also appeared insignificant. Conclusions Unless children are in severe deficiency in zinc and vitamin D, the children subjects belonged to either the short stature group or control group did not exhibit significant difference in growth parameter. This study should be compensated for subsequent studies because of comparatively small number of subjects. Besides, a systematic health management in community child welfare center seems necessary to help growth and development of short stature children. Keywords: Vitmain D, Zinc, Micronutrients, Growth