Evaluation and Treatment of Growth Failure in Children

In children, rate of growth can be a sensitive indicator of disease. Within the last decade, there have been major advances in the understanding of growth hormone deficiency and its impact on stature, especially short stature. Experts suggest that up to 75% of the cases of growth hormone (GH) deficiency may be reversible.

Physicians and endocrinologists now recognize that the growth effects of GH are mediated by a substance called insulin-like growth factor 1 (IGF-1). IGF-1, a potent growth and differentiation factor, stimulates the multiple processes leading to statural growth and is normally secreted in response to stimulation by GH. Some children with normal or elevated GH but in which short stature develops have traditionally been diagnosed with Idiopathic Short Stature (ISS), which means there is no known cause for their disease. Some new insights into the growth process have revealed certain children with ISS most likely have short stature caused by primary IGF-1 deficiency (primary IGFD), which is characterized by lack of IGF-1 production in the presence of normal or elevated levels of endogenous GH.

In this conversation, two pediatric endocrinology specialists, Dr. Naomi Neufeld and Dr. Paul Saenger, join Dr. Carlos Hamilton, Jr. to discuss current issues surrounding the evaluation and treatment of growth failure in children.

Related References/Reading:

  1. Dattani M, Preece M. Growth hormone deficiency and related disorders: insights into causation, diagnosis, and treatment. The Lancet 2004;363:1977-87.
  2. Laron Z. Laron syndrome (primary growth hormone resistance or insensitivity): the personal experience 1958-2003. J Clin Endocrinol Metab. 2004;89(3):1031-44.
  3. Lupu F, Terwilliger JD, Lee K, et al. Roles of growth hormone and insulin-like growth factor 1 in mouse postnatal growth. Dev Biol. 2001;229:141-162.
  4. Rosenthal S, Cohen P, Clayton P, et al. Treatment perspectives in idiopathic short stature with a focus on IGF-I deficiency. Pediatr Endocrinol Rev. 2007;4 Suppl 2:252-71.