Growth Disorders

Overview:
Growth is one of the complex and amasing facts of life that most people take for granted, but it can be a cause for concern for parents who have a child who’s shorter than others of the same age and doesn’t appear to be growing any taller.

Children of the same age vary greatly in height due to factors such as diet, genetics, and ethnic background. In most cases, tall or short stature is not abnormal and is due to a family tendency to be taller or shorter than average or to reach final height later than usual. Tall or short stature is a cause for concern only if the child’s height is well outside the average range for his or her age. Abnormally short or tall stature may be caused by a number of disorders.

What are the types?
Normal growth depends on a nutritionally adequate diet and good general health and is controlled by specific hormones. disruption of any of these three important factors may lead to a growth disorder that results in a child having abnormally short or tall stature.
short stature:
A child may be shorter than normal if his or her diet is inadequate. a chronic illness, such as cystic fibrosis or severe asthma, may also result in poor growth. crohn’s disease, a type of inflammatory bowel disease, is another example of a chronic illness that may lead to short stature. babies who have intrauterine growth retardation may reach a shorter than average height i later life.

Sometimes, short stature is caused by insufficient production of the hormones that are necessary for normal growth. in some children, the pituitary gland does not produce enough growth hormone. insufficient production of thyroid hormones is another cause of poor growth.

short stature is also a characteristic feature of tuner syndrome, a genetic disorder that only affects girls. in addition, short stature may occur as a result of a skeletal abnormality such as achondroplasia, an inherited disorder in which the bones of the legs and arms are shorter than normal.

Tall stature:
children may be temporarily taller than others of the same age and sex if puberty occurs early. however, in such children, the final height is usually normal. in very rare cases, exaggerated growth caused by the overproduction of growth hormone results in excessive height known as gigantism. the overproduction may be due to pituitary gland tumor. boys with the chromosome disorder klinefelter syndrome may also grow taller than normal at puberty.

Causes of delayed growth:
There are a large number of medical, genetic and external factors that can delay or inhibit normal growth. These include conditions such as Growth Hormone Deficiency (GHD) in children, Turner’s syndrome, Down’s syndrome, achondroplasia (defective growth of cartilage cells in the bones of the limbs) and various malfunctions of the endocrine system.

Chronic diseases and illnesses can also have a detrimental effect on growth including Inflammatory Bowel Disease IBD, chronic renal insufficiency and heart disease, as too can factors such as malnutrition, drug and alcohol abuse, neglect, chronic stress and lack of exercise. However, in many cases the cause of delayed or restricted growth is not known.

Many children are smaller than average during childhood yet end up reaching a normal adult height. But for some, a more normal adult height will not be achieved without treatment with supplemental human growth hormone (hGH). These include children with GHD and Turner’s syndrome.
A more common growth disorder is growth hormone deficiency (GHD). This is the condition of having too little GH. There are several possible explanations for its occurrence:

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A child can be born with GHD.
The condition also may arise because of damage to the hypothalamus or pituitary gland as a child or adult because of a tumor, an infection, or radiation to the brain — usually for the treatment of a tumor.
A deficiency in GH may also have an undefined cause. (In this case, it is said to be of idiopathic origin.)
Pituitary disorders, such as GH excess or GHD, are evaluated and treated by endocrinologists — medical specialists in hormone-related conditions. Because the diagnosis and treatment of such disorders require special expertise, primary care physicians who suspect patients have GH abnormalities should refer them to an endocrinologist.

One out of 2,500 to 5,000 children is born with a deficient growth hormone production resulting in impaired physical development, and another one in 2,000 to 2,500 girls are born with the genetic defect Turner’s syndrome. Both disorders may result in decreased final height, which may be improved by supplemental somatropin.

Growth Hormone Deficiency (GHD):-

In children
A child with an inadequate production of growth hormone (reduced or non-existent) may have a normal height and weight at birth, but the child’s physical development following birth is severely impaired.

The under-secretion of human growth hormone during childhood and puberty slows bone growth and teeth development, and also causes the growing plates of the long bones to close before normal height is reached. In addition, other organs of the body fail to grow and the body proportions remain childlike.

Without treatment the child with GHD risks the development of a range of complications, as well as having a short stature.

Turner’s syndrome
Turner’s syndrome is a common genetic defect that affects girls and women and occurs in about one out of every 2,000 to 2,500 female births.

In Turner’s syndrome all or part of one of the two X-chromosomes is missing, but the reason why this happens is not known. This defect can cause a number of physical and medical problems and in some cases creates educational and behavioural concerns.

Characteristics of Turner’s syndrome
As the extent of the defect to the chromosome varies, every case of Turner’s syndrome is individual and each affected girl may have only a few of the possible characteristics that can be associated with the syndrome.

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Short stature is a common characteristic of Turner’s syndrome resulting in a decreased final adult height and is generally accompanied by a failure of the ovaries and infertility.

Growth failure in Turner’s syndrome
The reasons for the growth retardation in Turner’s syndrome are not entirely understood, but patients are generally not deficient in growth hormone. The pituitary gland produces adequate amounts but the long bones do not respond.

The growth plates appear to be resistant to the action of the body’s GH, yet the hormone functions normally in controlling metabolism and organ development. By treating with supplemental hGH the resistance can be overcome, creating growth in the long bones. Female hormones may need to be given as well.

Being a genetic problem the affected individual will be faced with the consequences of the syndrome all her life, but can expect to lead a healthy life with appropriate care and treatment.

Growth Hormone Excess:
Excess growth hormone (GH) in children (gigantism) is extremely rare, occurring in fewer than 100 children in the United States.

Excess GH in adults (acromegaly) most commonly occurs in middle-aged men and women. Approximately 60 out of every million Americans have acromegaly.

Very infrequently, GH excess may run in families, or be one manifestation of a number of rare syndromes.

Frequent Sign & Symptoms:

The signs and symptoms depends upon the type of growth disorder. A child with a growth problem needs to be evaluated by a health care provider to determine the underlying health issues involved.

How is it diagnosed?
Your child’s height will be measured during routine checkups. if his or her height is consistently either lower or higher than the normal range, he or she will need to be measured frequently. If growth rates continue to be normal, tests may be performed to check hormone levels and to look for underlying disorders, such as genetic abnormality. in some cases, maturity of a child’s bones may be assesses by taking x-rays of the hand and wrist.

What is the treatment?
Treatment for growth disorders is most successful if started well before puberty when bones still have the potential for normal growth. short stature caused by an inadequate diet usually improves if the diet is modified while the child is still growing. If the growth disorder is a chronic illness, careful control of the illness can sometimes result in normal growth. growth hormone deficiency is usually treated by replacement of growth hormone. hypothyroidism is treated by replacing thyroid hormone.

Abnormal early puberty may be treated using drugs to halt the advancement gland tumor may be treated by removal of the tumor.

Treated early, most children with a growth disorder reach a relatively normal height, but, if treatment is delayed until puberty, normal height is more difficult to achieve. Abnormal stature may cause a child to be self-conscious and unhappy, and he or she may need support such as counseling.

Growth Hormone Excess: Treatment Options
Because excess GH — acting alone or together with excess IGF-1 — produces adverse health effects, reducing the levels to normal is desirable. Surgery, medication and/or irradiation of the pituitary gland may be appropriate to achieve these goals.

Growth Disorders Lifestyle and Prevention:
For children:
Because growth hormone is taken for years, it is good for parents of children with GHD to be aware of some safety precautions:

Carefully follow the directions for taking GH
Tell all doctors who care for your child that he or she is taking growth hormone
Make sure your child takes any other prescription drugs exactly as prescribed
Contact your child’s doctor immediately if you have any questions about treatment or signs or symptoms which suggest a complication of GH treatment.
In addition, encourage your child to have a healthy lifestyle. Eating a variety of healthy foods will help your child to grow and respond to growth hormone treatment. Be sure that your child gets regular exercise and plenty of sleep, too.

For adults:

Adults receiving GH treatment should also eat a balanced diet, get regular exercise, and plenty of sleep.

Some adults find their lives are much better after taking GH alone. Others may find they still need some help, particularly with the psychological symptoms of GHD. You may need medication to control anxiety or lift your mood.

Counseling may be helpful too. Some forms of therapy, such as cognitive-behavior therapy, can allow you to correct negative thoughts you may be having. You also may want to join a support group with other adults who have GHD. Talking to others who have been through the same thing can be healing.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.charak.com/DiseasePage.asp?thx=1&id=344
http://www.ferring.com/en/therapeutic/endo/About+Growth+Disorders/
http://www.hormone.org/Growth/overview.cfm

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