Abstract

PIP: Health providers examining children of short stature should assess adequacy of growth, determine growth rate, and predict final height with treatment. They can use established standards of growth to compare the child's height with that of other children of the same age to assess growth normalcy. If the child's height is lower than the 3rd/5th percentiles, the health provider must also determine whether the growth velocity is 3 cm/year by following the child for 6 months to 1 year, and whether retardation of skeletal maturity is of more than 2 bone age years to confirm abnormal growth. while the child is being followed for growth velocity, the health provider should prescribe a balanced nutritious diet. If these conditions are met and the child exhibits facial characteristics of growth hormone (GH) deficiency, central obesity, unusually small lower jaw, and prepuberal sex characteristics and behavior after usual age of puberty, the health provider can diagnose GH deficiency. 17% of children of short stature in a certain area of India have GH deficiency. The actual height, chronological age, and bone age are needed to predict the final adult height to monitor the impact of GH therapy. GH levels of less than 7 ng/ml in children not suffering from protein malnutrition suggest total GH deficiency. GH measurements must be done over 24 hours, since GH secretion is pulsatile. Sleep, exercise, and intravenous infusion of 0.5 g/kg body weight of arginine stimulates GH secretion. The most common pharmacologic tests to determine GH secretory status include insulin hypoglycemia and clonidine. Clonidine induces fewer side effects and is more safe than insulin hypoglycemia. Since a child can secrete normal amounts of GH with insulin hypoglycemia, the health provider should conduct 1 physiologic (sleep/exercise) test and 1-2 pharmacologic tests to diagnose GH deficiency.