Common Causes of short stature
Constitutional growth delay: This condition portrays kids who are little for their ages but their growth rate is typical ( aging, etc). They for the most part have a deferred "bone age," which implies that their skeletal development is more youthful than their age in years.
These kids don't have any signs or symptoms that influence development. They will, in general, arrive at adolescence later than their companions do, with a delay at the beginning of sexual improvement and the pubertal development spurt. But since they keep on developing until a more seasoned age.
Nutritional deficiencies: Children with nutritional deficiencies tend to have a delayed growth compared to their peers. This is generally manifested as the height and weight being lower than the lowest centiles on the growth charts.
Familial (or genetic) short stature: This is a condition wherein shorter parents will, in general, have shorter kids. This term applies to short kids who don't have any side effects of illnesses that influence their development. Children with familial short stature despite everything have development spurts and enter adolescence at ordinary ages, yet they, as a rule, will just arrive at tallness like that of their parents.
Endocrine diseases : They include a lack or overabundance of hormones and can be liable for development disappointment during youth and youthfulness. Growth hormone insufficiency is generally due to a defective pituitary gland may not deliver enough hormones for ordinary development. Hypothyroidism is a condition where the thyroid organ fails to make enough thyroid hormone, which is fundamental for typical bone development.
Turner syndrome: This is one of the most widely recognized hereditary development issues, happens in young girls and is a disorder where there's an absent or irregular X chromosome. Notwithstanding short stature, young ladies with Turner disorder ordinarily don't experience ordinary sexual advancement on the grounds that their ovaries neglect to develop and work regularly.
Management of Growth disorders
Most children have short stature because of one/both parents being short. This is best left alone as these children already have abundant growth hormone in their system. Children who have nutritional deficiency or underlying chronic illness will have catch up growth, once the underlying ailment is treated. It is imperative to check thyroid status in all children who are failing to achieve their target height. Thyroid disorders are a common reason for stunted growth and can easily be treatable. True Growth hormone deficiency is very rare and will require multiple sequential endocrine testing to confirm or exclude. MRI of the brain may also be essential.
Puberty is an internal clock designed by our body, which if triggered, will change the external features of a girl into a woman and a boy into a man. This clock is orchestrated by the sex hormone axis which includes the pituitary gland LH and FSH, and the sex hormones oestrogen and testosterone in the girl and boy respectively.
In boys, puberty occurs between ages 12-16. LH, FSH and Testosterone as a unit, are responsible for effects like male physique, beard growth, masculine voice, baldness, bone and muscle strength, sexual desire/erections and sperm production. A deficiency in these hormones can cause an impairment of the above functions in the male sex.
In girls, puberty occurs between ages 10-14. LH, FSH and oestrogen as a unit are responsible for the development of feminine stature, breast development, regulation of period and egg cycle, bone strength, skin tone and sexual function. A deficiency in these hormones can cause an impairment of the above functions in the female sex.
The various pubertal disorders are:
• Precocious puberty: This happens usually due to an early triggering of the clock leading to early puberty in boys and girls. It is important to treat this disorder, as early puberty will significantly reduce the final height of the girl/boy. Also children with early puberty may not be able to cope with the early sexual changes that are associated with puberty. The condition requires confirmation with sequential endocrine testing. Treatment is easy with monthly/3monthly injections and regular monitoring. Very rarely, the early puberty might be due to an abnormal growth in the pituitary/testes/ovaries or elsewhere which may necessitate surgery.
• Delayed puberty: This is where the pubertal clock has not triggered at an appropriate time. The common causes for this are:
• Constitutional delay- where puberty clock is lagging behind. There may be a hereditary aspect to this condition. Sometimes, a chronic illness can delay puberty in the child. No treatment is required and puberty will develop normally even if delayed.
• Pituitary failure/suppression - due to tumours or other pituitary pathology.
• Chromosome disorders - like Turner's syndrome in girls and Kleinfelter syndrome in boys.The condition requires confirmation with sequential endocrine testing. Hormone treatment is required to induce puberty, and depending on the condition may have to be continued for life
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