Paediatric Endocrinology, Top Ten Frequently Asked Questions

The commonest cause for short stature is nutritional deficiency. Other causes are genetic or familial short stature, constitutional short stature or late bloomer, chronic diseases and hormonal deficiency.

Among hormonal deficiencies, they are thyroid and growth hormone (GH) deficiency. Rare causes are Turner syndrome, growth retardation inside mother’s tummy and emotional deprivation.

Yes, there is a treatment for short stature. Initially, well-balanced diet with exercise, thyroid deficiency screening and treatment of chronic diseases are tried with regular growth monitoring.

If all these factors are corrected and growth is not adequate then tests are done to rule out growth hormone deficiency. Growth hormone deficiency is treated with growth hormone.

Hypothyroidism means thyroid hormone deficiency. It can occur at any age from newborn baby to old age. When a newborn baby develops hypothyroidism it is called congenital hypothyroidism.

It is one of the preventable causes of mental retardation. Earlier the diagnosis and treatment better is the outcome. Earlier diagnosis has been achieved with the introduction of newborn screening for congenital hypothyroidism.

Symptoms of congenital hypothyroidism are prolonged jaundice, constipation, excessive sleep, poor feeding, large tongue hoarse voice, etc. Symptoms in infancy and childhood are growth failure, constipation, dry skin, excessive sleep, etc.

New born screening means one drop of blood is collected by heel prick of the baby on 4th or 5th day of life and this sample is sent for thyroid hormone analysis.

The goal of treatment is to achieve normal serum thyroxine level rapidly to attain normal growth both physically and mentally. The treatment for hypothyroidism is oral thyroxine tablet, dose depending on the weight of the child.

Also, child needs to be regularly monitored for growth and development. Response to treatment is monitored by estimating serum thyroxine and TSH levels.

Low birth weight or small for dates or babies weight is inappropriately low for duration of the pregnancy. This inappropriate low weight indicates that growth of the baby in womb has been unsatisfactory and this is why it is called intra uterine growth retardation or IUGR.

Children with GH deficiency are short with normal body proportions and intelligence. Bone development may be delayed causing child to look younger than his actual age.

There may be under development of mid facial structure and frontal bossing of the skull. They are often obese / overweight as GH controls fat deposition.

Growth hormone is a hormone that regulates growth. GH deficiency occurs when pituitary gland (master gland, a small pea sized gland at the base of brain) fails to produce adequate amount of GH in the body.

After all other possibilities of short stature have been ruled out, tests are done for growth hormone deficiency. First analyse growth rate in the growth chart, second, thorough physical examination, X-ray of hand and wrist to see bone development and compare it with height and chronological age.

Confirmation is by giving the child a substance that releases growth hormone burst in normal children. If the release is suboptimal it confirms growth hormone deficiency.

It is an expensive medicine. Hence, it is not reachable by everybody. It needs to be given for a minimum period of one year and the cost increases if the child is older and heavier.

Adults cannot grow as their bones are fused. Once puberty is reached the sex hormones, oestrogen’s in girls and testosterone in boys cause fusion of bones. Once bones are fused we cannot grow anymore.