Etiology of short stature in children

To determine the causes of short stature in children with special emphasis on growth hormone deficiency. Case series. Department of Paediatrics, Military Hospital, Rawalpindi and Combined Military Hospital, Multan from September 2004 to January 2007. Two hundred and fourteen children [140 boys and 74 girls], ranging from 02 to 15 years presenting with short stature were studied. Height and weight were plotted on appropriate growth charts and centiles determined. Relevant hematological and biochemical investigations including thyroid profile were done. Bone age was determined in all cases. Growth hormone axis was investigated after excluding other causes. Karyotyping was done in selected cases. Data was analyzed by SPSS 10.0 by descriptive statistics. Mean values were compared using t-test. In this study, the five most common etiological factors in order of frequency were Constitutional Growth Delay [CGD], Familial Short Stature [FSS], malnutrition, coeliac disease and Growth Hormone Deficiency [GHD]. In 37.4% of patients, the study revealed normal variants of growth - CGD, FSS or combination of both, 46.7% cases had non-endocrinological and 15.9% had endocrinological etiology. CGD [22.1%] in males and FSS [27%] in females were the most common etiology. GHD was found in 6.1% children and it comprised 38.2% of all endocrinological causes. Children with height falling below 0.4[th] centile were more likely to have a pathological short stature [79.2%] compared to 39.3% whose height was below 3rd centile but above 0.4[th] centile [p<0.05]. CGD and FSS are most common causes of short stature in boys and girls respectively, whereas, GHD is a relatively uncommon etiology

Response of recombinant human growth hormone in isolated growth hormone deficiency

To observe the response of growth hormone in isolated growth hormone deficiency. Moreover the response was compared when treatment was initiated earlier or later in childhood. Quasi experimental study. The study was conducted in the department of paediatrics, Military Hospital Rawalpindi, from January 2001 to January 2006. Thirty children [19 boys, 11 girls] with isolated growth hormone deficiency, aged 3-17 years [mean 7.2 +/- 3.4] were identified. Their mean growth velocity was 1.8 cm/year [SD 0.6]. They were treated with intramuscular injections of recombinant human growth hormone [rhGHT] [0.1 U/ kg] 06 times a week for first three years of treatment. After three years of rhGHT the mean height gain was 33.5 cms [SD 8]. Mean height gain in 1st year was 15.5 cms [SD 4], in second year 10.4 cms [SD 2.8], in third year 7.6 cms [SD 2.0]. Mean total height gain was 40.6 cms [SD 4.2] when treatment was started before the age 06 years was 28.8 cms [SD 7.2] when treatment was started after the age 06 years [p < 0.05]. This study clearly demonstrates that children with isolated growth hormone deficiency treated with intramuscular rhGH resulted in increase in growth velocity but was more pronounced when started early [before age six years]