Hormonal profile among children with short stature

ABSTRACT

Linear growth occurs in 3 phases. During fetal and early infant life, growth is largely regulated by nutrition, during childhood by growth hormone [GH] and during puberty by GH and sex steroids. Short stature may be the normal expression of genetic potential, in which case the growth rate is normal at least at the 25[th] percentile, or it may be the result of a condition causing growth failure with a growth rate below the appropriate growth velocity for age. Short stature has been shown to have far reaching effects on psychological well being including poor academic achievement, behavioral problems, morbidity related to the underlying cause and increased risk for reduced bone mass. One hundred fifty-nine patients divided into 4 groups were studied. Group 1 [Pituitary dwarf] consisted of 26 patients [16 males and 10 females] aged 4-12 years. Group II [Congenital hypothyroidism] included 23 patients [14 males and 9 females] aged 2-12 years. Group III [Down's syndrome] consisted of 10 patients [5 males and 5 females] aged 3-12 years. A hundred apparently healthy children [50 males and 50 females] aged 2.5-12 years were considered as [Control group] group IV. All children were examined thoroughly, anthropometric measurements [14 items] were evaluated according to percentiles and Z-score diagrams. Bone age was determined by plain X-ray left wrist. Hormonal study was done including T[3], T[4], TSH, overnight urinary growth hormone [GH] and creatinine. Serum growth hormone [insulin-induced hypoglycemia test] and insulin like growth factor-1 [IGF-1] were measured for the pituitary dwarf group. The height, sitting height and arm span measurements showed a marked decrease below normal mean Z-scor e [more than -2SD] in the three studied groups of patients. Hormonal profile There was a significant decrease in serum levels of both T[3] and T[4] in congenital hypothyroidism and insignificant change in the other two groups. 3 patients from Down's syndrome group reached a hypothyroidal level of T[3], T[4], and TSH. Generally urinary growth hormone showed a significant decrease in the three studied groups of patients. Pituitary dwarf group showed a significant decrease in both serum and urinary growth hormones and also serum IGF-1 with a positive correlation between serum growth hormone and both urinary growth hormone and serum IGF-1. Height, sitting height and arm span are simple and accurate measurements for early detection and follow up of the short child. Assessment of the thyroid hormonal profile is essential as early as possible in all children with short stature with and without clinical stigmata of hypothyroidism. Determination of urinary growth hormone is as accurate as serum GH, moreover it is easier. Measurement of serum IGF-1 is an important era in diagnosis of short stature