Dwarfism

• I. DWARFISM

  ● Dwarfism is the hyposecretion of growth hormone by the anterior lobe of the pituitary gland.

  ● If growth hormones are deficient, children cannot grow to full size. As a

  result, children remain in proportion but well below the average on a standard growth chart.

  ● Possible Causes:

  1. A non-malignant cystic tumor, mostly craniopharyngioma, from embryonic origin that places pressure on the pituitary gland causing the hyposecretion of growth hormone.
  2. Genetic origin.
  3. Unknown cause. Among all these possible causes, hypopituitarism in children is mostly from unknown cause.
• ASSESSMENT

  ● Newborn is of normal size and weight at birth.

  ● Child is well-proportioned, but may be overweight for height.

  ● Underdeveloped jaw, abnormal position of teeth, high pitched

  voice, delayed puberty.

  Remember that a halted growth that is sudden suggests a tumor

  while a gradual one suggests an idiopathic involvement. If tumor is

  the cause, measures to remove it is necessary to hold the pituitary

  gland pressure causing insufficiency of the growth hormone

  secretion.
• DIAGNOSTIC TESTS

  1. Delayed closing of epiphyseal bones in x-ray. - That’s why there is a stunted growth.

  2. Normal IQ scores. - Because cognition is not affected.
• MANAGEMENT

  Without treatment, most children will not reach more than 3 or 4 feet in height.

  1. Administer IM recombinant human growth hormone (rhGH) 2 or 3 times a week.

  ● Growth hormone are usually given at bedtime, this is also the time of the day which growth hormone normally peaks.

  ● Because these children have delayed artificial closure, if treatment started early they will be able to reach a targeted height.
• 2. Some may need suppression of luteinizing hormonereleasing hormone (LHRH) or gonadotropin-releasing hormone (GnRH) to delay epiphyseal closure.

  ● To allow the IM growth hormone to act on the bones

  3. Other children may need supplements of gonadotropin or other pituitary hormones if these are also deficient.

  ● Because they are from the same affected pituitary gland
• 4. Children who do not respond to growth hormone stimulation may be offered a course of a newer synthetic recombinant insulin-like growth factor I.

  ● This is thought to be beneficial in growth

  5. Interact with child according to chronological or developmental age, and not with physical appearance.

  ● They are not mentally incapable, so we need to encourage child and parents to express their feeling
• 6. Surgical removal of tumor, if this is the cause.

  ● Although, idiopathic is the usual cause.

  ● If ever there is a tumor, monitor for signs and symptoms of additional neurologic impairment and it’s important to keep records of the height and the weight.