Diagnosis record: daughter is four years old, height 91, father 176, mother 156, bone age 3 years and 1 month. The doctor's initial diagnosis was that he was short stature and did not meet the standard of growth hormone. What do you think?
A: A girl, 4 years old, 91cm tall, -2.8SD tall, it is no problem to diagnose short stature. The father is 176, the mother is 156, and the genetic height is about 161.5, which is not bad, but according to the current height, it is likely that the genetic height will not be reached without treatment. The child had a growth hormone stimulation test, and the peak was 6.31, less than 10, indicating a growth hormone deficiency. However, there is a problem that the growth hormone stimulation test is affected by a variety of factors, and the measured values are not necessarily accurate. Stimulation with two drugs is generally required.
Q: There was no exercise before the stimulation test. What are the possible causes of growth hormone deficiency? Could it be what we often call a late length?
A: There are many causes of growth hormone deficiency, such as genetic mutations, hypothalamic pituitary tumors, and traumatic brain injury leading to hypothalamic pituitary gland damage. What we usually call medical "growth retardation" is called "physical pubertal retardation." This situation also exists, that is, puberty appears later than other children, which can last for two years, but after puberty comes, it grows up like other children.
What tests do I need to do for short stature?
If your child's height meets the diagnostic criteria for short stature above, we will first arrange a left-handed bone age tablet to see if there is any lag in bone age. If the diagnosis of short stature is consistent with a significantly different bone age of more than 1 year behind the actual age, we would recommend hospitalization. At the same time, based on history collection, systematic review, and physical examination, doctors will evaluate the presence of various pathological causes of short stature, and perform laboratory tests and/or imaging tests accordingly. For example, growth hormone stimulation test, pituitary magnetic resonance imaging, thyroid function, etc., girls will add chromosomes to rule out the possibility of congenital genetic diseases.
How do I interpret bone age test results?
Bone age test results include normal, bone age is large, and bone age is small. The difference between bone age and a person's actual age can be called bone age difference. Usually two years of age is considered the normal range of bone age difference, and when bone age difference is within one year of plus or minus one year is considered normal. When the actual age is greater than the bone age, the bone age is too small. Small bone age means that the child's bone development is backward and needs to be symptomatically treated after identifying the cause; when the actual age is less than the bone age, the bone age is too large. Older bones mean that children's bones develop ahead of schedule and need to find out the causes of improvement.
In general, delayed bone age may be due to growth hormone deficiency, hypothyroidism, malnutrition, congenital heart disease, chronic kidney disease, or severe asthma. At this time, the child may also have a delay in puberty, which has become what we often call "growing late", which should be checked. Of course, some children are genetic. For example, if the parents are not tall, the child's bone age may be normal, but the final height will not be very high.
If you have more questions about your child's "short stature", please comment below.