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Thread: Growth hormones

  1. #1
    Join Date
    Jul 2011
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    226

    Growth hormones

    We are in the beginning stages of testing my almost 3 year old for a growth hormone deficiency and/or ruling out other causes of her petite stature. She's been below the 3rd percentile for height and weight for a year now. Her line on the growth chart for that time frame is pretty much straight instead of an upward trend. I'm hesitant to head down this path because I anticipate being told she will require growth hormone injections. From the research I've done, this is not necessarily a cut and dry decision. Especially since we are a petite family. It's this fact that has made them hold off on testing but her growth is really a snails pace at this point. It is our pediatrician who ordered the preliminary tests and he will refer us to endocrinology most likely regardless of the outcome of those tests. I am compiling a list of questions and I'm just wondering if anyone has any experience in this vein with themselves or their children. Thanks!

  2. #3
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    The feature in what you've related which suggests it's not just due to having short parents is that she's lost percentiles as she's aged. Her growth isn't symmetric and on-track, but she's falling off the curve and at this point is 2 standard deviations below the mean height for her age. (If you both are quite petite-- you being <5', and he being 5'2- then she is symmetric, but your pediatrician will have assessed this). However, this is relatively common and as long as she hasn't crossed more than one percentile band (the dark lines on the growth chart-- 90-75-50-25-10)- it's less worrisome.

    Here are the questions I would ask:

    1) What is your differential diagnosis at this point (meaning, what conditions are you considering that she might have. Many things can lead to poor growth, from endocrinological deficiencies to thyroid disease to genetic syndromes to cystic fibrosis to malnutrition)?

    2) What tests will you perform to narrow the differential?

    3) What are the treatment options for the most likely suspects?

    4) For growth hormone injections, if that's what it turns out to be (and GH deficiency is comparatively quite rare)-- what is the injection schedule? For how long will you anticipate she will need them? Will you delay puberty (early puberty leads to prematurely fused epiphysites on the long bones and even shorter stature than otherwise predicted)?

    GH is usually not given to children who had a normal length/weight at birth unless their height falls below the 1st percentile. Usually no cause for short stature is found and the diagnosis is either Constitutional Growth Delay (the Delay part is great-- because these kids tend to have a growth spurt around puberty and track back up into the normal ranges, albeit staying petite) or Idiopathic Short Stature (no cause is ever found and it doesn't reverse itself). Again they usually aren't treated unless
    Blade, MD

    XY: Antoine Raphael
    XX: Cassia Viviane Noor

    Aquila * Chrysanthe * Emmanuelle * Endellion * Ione * Jacinda * Lysandra * Melisande * Mireia * Petra * Rosamond * Seraphine * Silvana * Theophane / Blaise * Cyprian * Darius * Evander * Giles * Laurence * Lionel * Malcolm * Marius * Peregrine * Rainier

    كنوز الصحراء الشرقية Hayat _ Qamar _ Sahar _ Amal _ Hanan / Altair _ Fahd _ Ilyas _ Sajjad _ Saqr _ Tariq

  3. #5
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    Jul 2011
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    Thank you Blade. From your information it would seem unlikely she has a true deficiency (she was 6lbs 7oz at birth and 18.5"; I'm 5', DH is 5'8) but that is what her pediatrician is leaning toward.

    Right now, in addition to testing IGF and bone age we are testing thyroid plus a chem screen and CBC w diff. We really just began this process.

    I think it's the possible differentials that scare me the most (like some rare genetic disease). Other than her stature the only things to note is she is quite flexible/double jointed and as a baby had some mild right sided weakness that mostly corrected itself around 18months. She was evaluated for this at the time at it was likened to a transient CP (which I didn't know was a thing). My concern is missing a clue here.

    People (husband, mom) think I'm a little paranoid because truly she is a happy, energetic, smart and funny little girl. But I'm a mom and I worry....

  4. #7
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    Of course you worry. It's normal. Her adult height using the * really* rough rule of thumb "average parents' heights and subtract 2.5 inches for a girl, add 2.5 for a boy" means she's predicted to be 5'2"- 5'3", so at the third percentile she's not growing on track to reach that (4'11" is the 3rd percentile for adult women). But again she doesn't yet meet indications for GH, the most common diagnosis is CGD, and usually the lab tests return completely negative and no cause is found.
    Blade, MD

    XY: Antoine Raphael
    XX: Cassia Viviane Noor

    Aquila * Chrysanthe * Emmanuelle * Endellion * Ione * Jacinda * Lysandra * Melisande * Mireia * Petra * Rosamond * Seraphine * Silvana * Theophane / Blaise * Cyprian * Darius * Evander * Giles * Laurence * Lionel * Malcolm * Marius * Peregrine * Rainier

    كنوز الصحراء الشرقية Hayat _ Qamar _ Sahar _ Amal _ Hanan / Altair _ Fahd _ Ilyas _ Sajjad _ Saqr _ Tariq

  5. #9
    Join Date
    Jul 2011
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    226
    Thanks again blade. We will go next week for testing and see where we go from there...

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