|
What is
short Height (Dwarfism) i.e. short height is defined
when child is not growing as compared to others in a given
geographical region, the moment you feel your child is shorter
than others you should consult Mediplex immediately otherwise
later you may not have enough time for treatment.
Height increase is influenced by genetic factors, stress,
nutrition levels, exercise, diseases such as hormonal imbalances,
age etc.
Mechanism
of Growth: In children the various hormones (as growth
hormone, Thyroid Hormone, sex hormones, adrenal hormone
androstenidione, 17-oh Progesterone, DHEAS, LH, FSH, plays the
role in height increase. Also many minerals, nutrients also
required for good height growth. These hormones, minerals &
micronutrients lead to increased concentration of IGF-1 & some
other hormones. These hormones then act on the various sensors
(called receptors) in the growth plate of bone. After the
interaction of hormones & receptors certain changes occurs in
the functioning of cells of growth plate of long bones tissue so
that growth plate cells starts growing in thickness & size
& more & more new bone starts depositing in the bone thus
growth plate size gradually starts increasing. Simultaneously it
also increases the blood supply to growth plate tissue leading to
more availability of growth factors to the growth plate tissue
resulting in faster growth of growth plate tissue. These hormones
& growth factors are in high concentration during peak of
secondary sexual characters development i.e. puberty leading to
persistent stimulation of growth plate for next two to three years
i.e. up to completion of sexual development. Thus in children in
two to three years full height growth occurs.
Causes
of short height are:
Genetics
Metabolic Blocks
Hormone Disorder: Growth hormone deficiency, thyroid
hormone deficiency, cortisol excess,
Mineral Disorder: Vitamin D, Zinc, Calcium, Iron
deficiency, osteomalacia, rickets, hereditary (genetic)
Rickets (Vitamin D deficiency or hypophosphataemic
Skeletal dysplasia: (Achondroplasia, Hypochondroplasia)
Chromosomal defect (as Downs's Syndrome, Turner Syndrome),
Systemic Diseases: CNS, Cardiac diseases, Renal tubular
acidosis, kidney failure & Chronic Systemic diseases ,Chronic
Renal disease : CRF, RTA , Hematologic disease :Anemia d/t
Thallasemia major sickel cell anemia ,Uncontrolled Diabetes
,Cardiac disease: Cynotic heart disease, CHF d/t any cause.
many other causes
Familial short stature (genetic), Constitutional delayed growth
with or without delayed puberty,
Malnutrition, anemia, Under nutrition (of calorie, protein,
vitamin-D & Zinc)
Dysmorphic syndromes (Primordial dwarf):Russel Silver
Syndrome,Noonan Syndrome ,Praderwilli Syndrome ,Pseudohypoparathyroidism
, LMB Synd., Progeria , Intrauterine growth retardation
Psycho-social Dwarfism
Malabsorption: Celiac diseases, chron’s disease & Chronic
Giardiasis.,
Inborn errors of Metabolism (Mucopolysacharidosis, Galactosemia)
CNS Disease: Mental retardation
Idiopathic Short Stature
Approach
to Diagnosis of Short Stature
Detailed History: First we
take detail history about diet, past illness & other relevant
history to reach on probable cause for shortness of height. Birth
history (breech delivery, preterm), Height, Weight at birth, Early
developmental milestones, Scholastic performance, Dietary intake
(in present & past)
Any systemic disease (in present & past), History suggestive
of Hypothyroidism, Cushing’s disease or syndrome, Growth hormone
deficiency, History of steroid intake Psycho-social history,
Family history of Short height & delayed growth & puberty
(in parents, 1st & 2nd degree relatives) Old height &
weight records.
Physical Examination: We look
for anemia, signs of malnutrition, Rickets, Neck for goiter, then
we do Systemic examination- Organomegaly & CVS, Respiratory
system, Central Nervous system is examined for any cause in CNS
& Intellect, Fundus for Papilloedema &optic-atrophy. We
also Look for signs of Growth hormone deficiency, Hypothyroidism,
for congenital anomalies in face, neck, hand, chest, leg &
body for primordial dwarf, turner syndrome, Measure Weight,
calculate weight age, calculate relationship of weight age to
height age.
If weight for height is less (weight. age less than height. age)
i.e. child is underweight the chance of Nutritional short height
or malabsorption as cause is more likely. If weight for height is
more (i.e. weight. age > height. age) then chances of endocrine
i.e. hormone disorder as cause for short height is more likely.
ADVANCED HOMEOAPATHIC APPROACH
We go into root cause of the problem by analyzing its genetic
makeup, metabolic system, mind and physical symptoms.
Investigation
& Diagnosis:
After detail history & examination whatever hormone
deficiency is suspected is investigated.
For this we do following tests:
Hormone test: as growth
hormones, thyroid (Free T4, Free T3, TSH), FSH, LH, testosterone,
estradiol, IGF-1, IGFBP-3,etc.
Bio-chemical test: (Hb.,
ESR, GBP, Alkaline.Phosphatase, Calcium, Phosphorus, Urea,
creatinine, Urine Protein, M/E ,Fasting urinary ph , Serum
bicarbonate,Serum Potassium ,Serum protein, SGPT Stool Fat ,
Tests to diagnose other systemic diseases
x-ray Skull,
Bone age (skeletal age) test
Short
height due to Growth hormone deficiency: Growth hormone
deficiency is one of the common causes of short height. Growth
hormone formation becomes less in body due to inability of growth
hormone secreting glands to make GH hormone from birth due to
defect in gland functioning itself which is called congenital
growth hormone deficiency. Then other cause are those cases in
which growth hormone deficiency occurs later in life due to some
damage to growth hormone forming gland later in life such as due
to idiopathic growth hormone deficiency , tumour or trauma. G.H.
ineffectiveness, hypopituitarism, Isolated growth hormone
deficiency, Biologically inactive growth hormone, acquired
idiopathic growth hormone deficiency, psychosocial deprivation
syndrome.
Clinical Feature: During
infancy or childhood child may suffer with recurring irritability
due to low blood sugar, Prolonged jaundice, small genital,
cryptorchidism in male, During Child hood children with growth
hormone deficiency present with short height, Childish look,
obesity with prominent abdominal adiposity, prominent forehead,
lower face is small, normal intelligence, normally active, and
normal body proportions & no other disease that would cause
growth failure, sexual development is also often delayed,
wrinkling of face or body, fatigue (Weakness), depression &
decreased body strength, bone weakness etc. Diagnosis of short
height due to growth hormone deficiency is made by low GH, IGF-1,
IGF-BP-3
For consultation & treatment (by appointment / or
online)
Call at 9313520295 or send email at Mediplex@gmail.com
|