--posting due by July 13th
In recent history, treatment for “short stature” in children has become quite popular. What are the treatments for short stature? What determines short stature syndrome as compared to a child that is simply shorter than their classmates?
Tuesday, July 17, 2007
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Medical treatment depends on the cause of short stature. For children with normal variant short stature, generally no treatment is necessary. It is essential for parents to understand that growth hormone is not effective at increasing final adult height in children with short stature who are normal (that is, they lack disease).
Thyroid hormone replacement therapy is simple and effective for children with hypothyroidism. Recombinant human growth hormone therapy (somatotropin of rDNA origin) is highly effective and safe for growth failure due to growth hormone deficiency and FDA-approved for several other conditions associated with short stature. However, growth hormone is not effective for normal children with short stature (that is, familial short stature). Growth hormone should be administered under the care of a pediatric endocrinologist.
All causes of short stature fall into one of three major categories: chronic disease (for example, malnutrition), familial short stature, or constitutional delay of growth and development ("late bloomers"). Worldwide, malnutrition is the most common cause of growth failure and is usually related to poverty or anarchy. Nutritional deficiencies in developed countries are more often the result of self-restricted diets. Poor weight gain is often more noticeable than short stature.
Children with familial short stature have short parents. These normal children display normal growth velocity (speed of growth over time), and their bone development is normal (as indicated by the bone age corresponding to the calendar age). Children with familial short stature enter puberty at a normal time and typically complete growth with a height consistent with that of their parents.
Constitutional growth delay is a term used to describe normal children who are small for their age but who have a normal growth rate. Constitutional growth delay is characterized by delayed bone age, normal growth velocity, and a predicted adult height appropriate to the family pattern. Children with constitutional growth delay, often called "late bloomers," typically have a close relative who displayed constitutional growth delay. For example, the relative with late blooming may have had her first menstrual period when she was older than 15 years. A male relative with late blooming may have reached his final adult height after age 18 years.
http://www.emedicinehealth.com/short_stature_in_children/
-Treatment:
The Food and Drug Administration (FDA) today approved a new indication for Humatrope (Somatropin, rDNA origin, for injection), a brand of growth hormone, for the long-term treatment of children with idiopathic (of unknown origin) short stature, also called non-growth hormone deficient short stature.
Certain types of growth hormone seem to increase the rate of growth during the first year of life/treatment, but has no substantial effect once in adulthood. Only a few surgical centers in the world perform, experiementally, leg and arm lengthening procedures. Most common therapies are found in seeking help from: family physicans, Pediatrics, internists, endocrinologists, geneticists, orthopedists and neurologists
http://en.wikipedia.org/wiki/Chondrodystrophy
-What determines Short Stature:
"Short stature" has been defined by the American Association of Clinical Endocrinologists and the Growth Hormone Research Society as height more than 2 standard deviations (SD) below the mean for age and sex.
http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01242.html
-Diagnosis
There are several ways to determine if a child has Chondrodystrophy including parent testing and x-rays. If the fetus is suspected of having Chondrodystrophy, the parents can be tested to find out if the fetus in fact does have the disease. It is not until the baby is born that a diagnosis can be declared. The diagnosis is declared through several x-rays and charted bone growth patterns. Once the child is diagnosed the parents have to monitor the children because of several different factors. As the child gets older, hearing, eye sight and motor skills may be defective. Also, breathing (apnea) and weight problems (obesity) may occur. Structurally, scoliosis, bowed legs (genu varus), and arthritis may result.
http://en.wikipedia.org/wiki/Chondrodystrophy My wiki page from AP
Treatment with medication depends on the cause of short stature. Thyroid hormone replacement therapy is simple and effective for children with hypothyroidism. Recombinant human growth hormone therapy (somatotropin of rDNA origin) is highly effective and safe for growth failure due to growth hormone deficiency and FDA-approved for several other conditions associated with short stature. The FDA has approved Eli Lilly's Humatrope (Somatropin, rDNA origin, for injection) for the shortest 1.2% of children - those predicted to grow to adults shorter than 5 feet, 3 inches for males, and 4 feet, 11 inches for females. The drug is indicated for those children who are more than 2.25 standard deviations below the mean for age and sex. For 10 yr olds, this would correspond to a height of less than 4 feet, 1 inch. The drug is not meant for normal children seeking to be a few inches taller. Humatrope is given by injection, up to six times per week. The drug was previously indicated for treatment of growth hormone deficiency. However, growth hormone is not effective for normal children with short stature.
http://www.emedicinehealth.com/short_stature_in_children/article_em.htm
www.pharmacist.com/articles/h_ts_0340.cfm
Their are many medical causes for being short and having poor growth, including growth hormone deficiency, hypothyroidism, Turner Syndrome, inflammatory bowel disease, kidney problems, malnutrition. Most children who are short are normal. They just hve a genetic short stature or a constitutional growth delay.
It is also important to look at a child's weight, in relation to his height. Since overweight or obese children are usually very tall because of an accelerated growth rate, if your child is short and overweight, then he should be evaluated for a medical condition causing his growth problems.Among the tests that are commonly performed to evaluate the growth of a child with short stature include determining a bone age, which is the chronological age of your child's bones. This is determined by taking an xray, usually of his left wrist and hand. If your child's bone age is much less than his chronological or real age, then there is probably still room for his bones to grow after the age that you would normally expect him to already stop growing. Girls usually continue to grow until a bone age of about 14 years, and boys stop growing after a bone age of 16 years.
Treatments for growth hormone deficiency include growth hormone replacement. Other conditions for which growth hormone is currently being successfully used include Turner syndrome, chronic renal failure and Prader-Willi syndrome.
Recently, the indications for which kids can be treated with growth hormone has been expanded. Growth hormone can now be used for the long-term treatment of children with idiopathic (of unknown origin) short stature, also called non-growth hormone deficient short stature, who are more than 2.25 SD below the mean for age and sex, or the shortest 1.2% of children. For example, according to the FDA, for 10-year old boys and girls, this would correspond to heights of less than 4' 1" inch. This would further correspond to heights of less than 5' 3" and 4' 11" in adult men and women, respectively.
Some new studies and reports have recently shown that another group of these short kids, those who were born Small for Gestational Age (SGA), may also benefit from treatment with human growth hormone. The International Small for Gestational Advisory Board has recommended that if 'a short child who was born SGA has not caught up by age 2 to 3 years of age and whose catch-up growth has stopped should be referred to a pediatrician who has expertise in endocrinology.
http://www.keepkidshealthy.com/welcome/conditions/short_stature.html
http://www.emedicine.com/ped/topic2087.htm
There is a growth hormone therapy called Norditropin and it is used in children who have Noonan syndrome. Noonan syndrome is an autosomal dominant genetic syndrome; so if one parent passes on the Noonan gene than the child will be affected. These children usually have short stature, widely set eyes, a webbed neck and congenital heart syndrome. These children fail to grow because they don’t produce enough growth hormone. Reasons for one to have short stature can be hormone deficiencies (hypothalamic disease, surgery, trauma, genetic, or radiation therapy). Norditropin is of a somatropin rDNA origin. It’s an injected medication used to treat children with short stature syndrome.
http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/06-01-2007/0004599732&EDATE=
There can be many different reasons for a child having short stature syndrome including growth hormone deficiency, hypothyroidism, Turner syndrome, inflammatory bowel disease, kidney problems, malnutrition, and genetic reasons. Children who are diagnosed with short stature usually fall below the third and fifth percentile on their growth charts, and their height falls at least two standard deviations below the mean for that specific gender and age. To diagnose short stature syndrome a bone age test using and X-ray of the wrist bones can be conducted. If the determined bone age is less than the child’s chronological age there is still room for the child’s bones to grow later than the age expected. Other diagnostic test include blood test to check for hypothyroidism, growth hormone levels, complete blood counts, blood chemistries, urinalysis, and karyotyping for chromosomal abnormalities. Treatment varies depending on the cause of short stature. If hypothyroidism is the cause thyroid replacement therapy is necessary. However, if the cause is a growth hormone deficiency a recombinant human growth hormone therapy such as Humatrope can be used.
www.fda.gov
www.keepkidshealthy.com/welcome/conditions/short_stature.html
Treatments for Short Stature: The only treatment I could find currently available included growth hormones including Humatrope.
Classification of Short Stature Syndrome: Children with short stature are usually below the 3rd or 5th percentile on their growth chart for their height. But just as important as where they are on or below the growth chart is what their growth velocity or rate of growth has been each year. Two common test to test for Short Stature include bone age test, blood test,and family history. Constitutional delay in growth is another normal symptom of Short Stature.
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http://tinyurl.com/2v23kx
http://tinyurl.com/3blnt3
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