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Wang L. [Attaching great importance to the scientific assessment of short stature in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1095-1100. [PMID: 37990451 PMCID: PMC10672958 DOI: 10.7499/j.issn.1008-8830.2308063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/10/2023] [Indexed: 11/23/2023]
Abstract
Short stature is a common physical developmental abnormality in children. Without timely and accurate diagnosis, as well as early intervention, it can impose a heavy burden on the children and their families. There are numerous causes for short stature, and the diagnostic process essentially involves identifying its underlying causes. Based on a thorough understanding of the regular patterns of child physical development and the characteristics of individuals at high risk of short stature, a scientific definition of short stature needs to be established, along with standardized diagnostic and treatment protocols, to achieve early diagnosis or referral for short stature. Furthermore, it is necessary to enhance scientific awareness of short stature among parents and primary care pediatricians, in order to avoid over-treatment, missed diagnoses, and misdiagnoses arising from "misconceptions", and to improve the scientific assessment of short stature.
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Affiliation(s)
- Lin Wang
- Center of Children's Healthcare, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China (. cn)
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Kim SJ, Jin JH, Chung IH. Relationship between short stature at 3 years old and height, weight, and body mass index changes for 6 years after birth: a retrospective, nationwide, population-based study of children born 2011-2014 in Korea. Ann Pediatr Endocrinol Metab 2023; 28:193-199. [PMID: 36758974 PMCID: PMC10556449 DOI: 10.6065/apem.2244190.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Height at 3 years of age, when catch-up growth based on birth history is completed, is considered a major prognostic factor for predicting short stature, underweight, and growth faltering. However, too few large-scale studies have followed and analyzed height, weight, and body mass index (BMI) changes in children whose stature was short at 3 years of age. This study followed and compared the growth parameters (height, weight, and BMI) of children with short stature at 3 years of age and children with nonshort stature at 3 years of age for 6 years after birth using nationwide, population-based data. METHODS We retrospectively analyzed physical measurement data from the National Health Screening Program for Infants and Children for people born in 2011-2014 in Korea and followed to 2020. The data were provided by the National Health Insurance Service's customized data service. Growth parameters were compared using chi-square tests, Student t-tests, analyses of variance, and linear regressions. RESULTS Among 210,902 enrolled participants, 759 (0.4%) and 210,143 (99.6%) were in the short stature at 3 years group and the nonshort stature at 3 years group, respectively. In both sexes, height, weight, and BMI for 6 years after birth were significantly higher in the nonshort stature at 3 years group than in the short stature at 3 years group (P<0.0001). The BMI rebound was observed later than the standard period in the short stature at 3 years group. CONCLUSION Early intervention and close follow-up are necessary to prevent persistent short stature and growth faltering in children with short stature at 3 years of age.
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Affiliation(s)
- Seo Jung Kim
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Hyun Jin
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - In Hyuk Chung
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Pérez-Pérez A, Alonso Alonso A, González García A, Riaño Galán I. Growth hormone treatment in pediatrics: What can we improve? ENDOCRINOL DIAB NUTR 2023:S2530-0180(23)00087-2. [PMID: 37210269 DOI: 10.1016/j.endien.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/19/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To analyze the age at which treatment with growth hormone (GH) is started in the different indications approved in our country, as well as to assess the response to it and detect points of improvement. MATERIAL AND METHODS A descriptive, observational and retrospective study of pediatric patients receiving GH treatment in December 2020 and monitored in the pediatric Endocrinology Unit of a tertiary care hospital. RESULTS A total of 111 patients (52 females) were included in the study. The mean age at the start of treatment was 6.6 years old, being delayed in all diagnostic groups with respect to what is approved for each indication. The indication for which they most frequently received treatment was GH deficiency (n = 60, 54%). In this diagnostic group, there is a predominance of males (39 boys vs 21 girls, and a significantly greater increase in height z score (greater height SDS) is observed in those with early start of treatment compared to those who start late (greaterheight SDS 0.93 vs 0.6; P < .05). All diagnostic groups presented a greater height SDS and height velocity. No adverse effects were observed in any patient. CONCLUSION GH treatment is effective and safe for the approved indications. The age of initiation of treatment is a point to improve in all indications, especially in SGA patients. For this, good coordination between primary care pediatricians and pediatric endocrinologists is essential, as well as specific training to identify early signs of different pathologies.
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Affiliation(s)
- Alicia Pérez-Pérez
- Unidad de Endocrinología Pediátrica, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Aroa Alonso Alonso
- Unidad de Endocrinología Pediátrica, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Andrea González García
- Unidad de Endocrinología Pediátrica, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Isolina Riaño Galán
- Unidad de Endocrinología Pediátrica, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain
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Kaplan W, Al Amiri E, Attia N, Al Basiri I, Romany I, Al Shehri E, Al Twaim A, Al Yaarubi S, Deeb A. Assessment and referral of patients with short stature by primary care physicians in the Arabian gulf region: Current perspectives from a regional survey. Front Pediatr 2022; 10:988614. [PMID: 36507126 PMCID: PMC9732663 DOI: 10.3389/fped.2022.988614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/26/2022] [Indexed: 11/26/2022] Open
Abstract
Children with short stature are frequently referred late to pediatric endocrinologists in the Arabian Gulf region. This is likely a contributing factor to late initiation of treatment despite current evidence suggesting that children with short stature have better outcomes with earlier treatment. This delay in referral could be due to a lack of identification or proper assessment of short stature by front-line physicians. To analyze the assessment and perception of short stature in this group of physicians, an expert group of pediatric endocrinologists developed and disseminated an anonymous online survey of 22 multiple choice questions amongst general pediatricians, pediatric subspecialists, and family medicine physicians in the Arabian Gulf region. Of the 640 respondents, 450 completed the survey (70.3% completion rate). While most surveyed physicians use the correct definition for short stature in children, only 24% reported a consistent use of a wall-mounted stadiometer. Of the respondents, 50% or less would consider referring clinical conditions other than growth hormone (GH) deficiency or idiopathic short stature, 41% would refer a child with short stature as soon as height dropped below the 5th percentile, 57% considered GH a treatment option for short stature, and only 60% consider GH treatment safe. The results of this survey demonstrate knowledge gaps in short stature assessment and referral that need to be addressed through education on short stature amongst target physicians, and lay groundwork for future recommendations to address those gaps in the Arabian Gulf region.
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Affiliation(s)
- W Kaplan
- Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates
| | - E Al Amiri
- Diabetes and Endocrine Unit, Department of Pediatrics, Al Qasimi Women and Children Hospital, Sharjah, United Arab Emirates
| | - N Attia
- Pediatric Endocrine Unit, Department of Pediatrics, King Abdulaziz Medical City and King Abdullah Research Centre, Jeddah, Saudi Arabia
| | - I Al Basiri
- Diabetic and Endocrine Unit, Department of Pediatrics, Mubarak Al Kabeer Hospital, Kuwait City, Kuwait
| | - I Romany
- Department of Medical Affairs, Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | - E Al Shehri
- Department of Pediatrics, International Diabetes Care Center, Jeddah, Saudi Arabia.,Pediatric Endocrine Division, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - A Al Twaim
- Department of Pediatrics, International Diabetes Care Center, Jeddah, Saudi Arabia
| | - S Al Yaarubi
- Department of Pediatrics, Oman Medical Specialty Board, College of Medicine and Health Science, Muscat, Oman
| | - A Deeb
- Division of Paediatric Endocrinology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.,College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
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TURAN İ. Çocuk endokrinolojisi polikliniğinde boy kısalığına tanısal yaklaşım ve yeşil alan uygulamasının etkinliği. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.950240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Labarta JI, Ranke MB, Maghnie M, Martin D, Guazzarotti L, Pfäffle R, Koledova E, Wit JM. Important Tools for Use by Pediatric Endocrinologists in the Assessment of Short Stature. J Clin Res Pediatr Endocrinol 2021; 13:124-135. [PMID: 33006554 PMCID: PMC8186334 DOI: 10.4274/jcrpe.galenos.2020.2020.0206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Assessment and management of children with growth failure has improved greatly over recent years. However, there remains a strong potential for further improvements by using novel digital techniques. A panel of experts discussed developments in digitalization of a number of important tools used by pediatric endocrinologists at the third 360° European Meeting on Growth and Endocrine Disorders, funded by Merck KGaA, Germany, and this review is based on those discussions. It was reported that electronic monitoring and new algorithms have been devised that are providing more sensitive referral for short stature. In addition, computer programs have improved ways in which diagnoses are coded for use by various groups including healthcare providers and government health systems. Innovative cranial imaging techniques have been devised that are considered safer than using gadolinium contrast agents and are also more sensitive and accurate. Deep-learning neural networks are changing the way that bone age and bone health are assessed, which are more objective than standard methodologies. Models for prediction of growth response to growth hormone (GH) treatment are being improved by applying novel artificial intelligence methods that can identify non-linear and linear factors that relate to response, providing more accurate predictions. Determination and interpretation of insulin-like growth factor-1 (IGF-1) levels are becoming more standardized and consistent, for evaluation across different patient groups, and computer-learning models indicate that baseline IGF-1 standard deviation score is among the most important indicators of GH therapy response. While physicians involved in child growth and treatment of disorders resulting in growth failure need to be aware of, and keep abreast of, these latest developments, treatment decisions and management should continue to be based on clinical decisions. New digital technologies and advancements in the field should be aimed at improving clinical decisions, making greater standardization of assessment and facilitating patient-centered approaches.
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Affiliation(s)
- José I. Labarta
- University of Zaragoza, Children’s Hospital Miguel Servet, Instituto de Investigación Sanitaria de Aragón, Unit of Endocrinology, Zaragoza, Spain,* Address for Correspondence: University of Zaragoza, Children’s Hospital Miguel Servet, Instituto de Investigación Sanitaria de Aragón, Unit of Endocrinology, Zaragoza, Spain Phone: +34 976 765649 E-mail:
| | - Michael B. Ranke
- University of Tübingen, Children’s Hospital, Clinic of Pediatric Endocrinology, Tübingen, Germany
| | - Mohamad Maghnie
- University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy,IRCCS Instituto Giannina Gaslini, Department of Pediatrics, Genova, Italy
| | - David Martin
- University of Witten/Herdecke and Tübingen University, Tübingen, Germany
| | - Laura Guazzarotti
- University of Milan, Luigi Sacco Hospital, Clinic of Pediatric, Milan, Italy
| | - Roland Pfäffle
- University of Leipzig, Department of Pediatrics, Leipzig, Germany
| | | | - Jan M. Wit
- Leiden University Medical Centre, Department of Paediatrics, Leiden, Netherlands
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Alassaf A, Gharaibeh L, Ibrahim S, Odeh R. Etiologies, profile patterns and characteristics of children with short stature in Jordan. J Pediatr Endocrinol Metab 2021; 34:559-565. [PMID: 33851794 DOI: 10.1515/jpem-2020-0672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Childhood growth influences their social and psychological behavior, and abnormal growth may reflect underlying pathological etiologies. It is important to diagnose children with short stature as early as possible to be able to manage treatable causes. We aim to study etiologies and characteristics of short stature in children in Jordan. METHODS This is a cross-sectional retrospective review of the medical records of children diagnosed with short stature at a referral university hospital. Clinical characteristics, auxological, laboratory, and radiological investigations were collected and analyzed. RESULTS Among a total of 551 children diagnosed with short stature, the number of boys was significantly higher than girls, 304 (55.2%) and 247 (44.8%), respectively with a p-value of 0.015. Average age at presentation for all patients was 10.24 ± 3.23, with no significant difference between boys and girls. Pathological etiology was higher than normal variants 55.7 and 44.3%, respectively with p=0.007. Constitutional delay of growth and puberty (CDGP) was the most frequent cause in the normal variant group, 59.8%. Among the pathological group, the most common etiology was growth hormone deficiency (32.2%) with mean age of presentation of 9.40 years and was not significantly different from the age in other etiological groups, 9.44 years and p=0.931. CONCLUSIONS Growth monitoring of children should start at an early age for boys and girls. Referral to the pediatric endocrine clinic should be considered when growth problems are suspected for accurate diagnosis and etiology profiling.
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Affiliation(s)
- Abeer Alassaf
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Sarah Ibrahim
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Rasha Odeh
- Department of Pediatrics, The University of Jordan, Amman, Jordan
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Zervas A, Chrousos G, Livadas S. Snow White and the Seven Dwarfs: a fairytale for endocrinologists. Endocr Connect 2021; 10:R189-R199. [PMID: 33878729 PMCID: PMC8183629 DOI: 10.1530/ec-20-0615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
Abstract
'Snow White and the Seven Dwarfs', a fairytale that is widely known across the Western world, was originally written by the Brothers Grimm, and published in 1812 as 'Snow White'. Though each dwarf was first given an individual name in the 1912 Broadway play, in Walt Disney's 1937 film 'Snow White and the Seven Dwarfs', they were renamed, and the dwarfs have become household names. It is well known that myths, fables, and fairytales, though appearing to be merely children's tales about fictional magical beings and places, have, more often than not, originated from real facts. Therefore, the presence of the seven brothers with short stature in the story is, from an endocrinological point of view, highly intriguing, in fact, thrilling. The diversity of the phenotypes among the seven dwarfs is also stimulating, although puzzling. We undertook a differential diagnosis of their common underlying disorder based on the original Disney production's drawings and the unique characteristics of these little gentlemen, while we additionally evaluated several causes of short stature and, focusing on endocrine disorders that could lead to these clinical features among siblings, we have, we believe, been able to reveal the underlying disease depicted in this archetypal tale.
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Affiliation(s)
| | - George Chrousos
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Athens, Greece
- National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece
| | - Sarantis Livadas
- Endocrine Unit, Athens Medical Centre, Athens, Greece
- Correspondence should be addressed to S Livadas:
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A Retrospective Analysis of Patients with Short Stature in Eastern China between 2013 and 2019. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6640026. [PMID: 33997034 PMCID: PMC8081605 DOI: 10.1155/2021/6640026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
Objective To identify the aetiology of growth and development diseases and assess the long-term effectiveness of recombinant human growth hormone (rhGH) therapy in a real-life clinical setting and provide better guidance in clinical strategy and decision making. Methods This retrospective study included 1145 children and adolescents with short stature admitted to the Department of Endocrinology, Affiliated Hospital of Jining Medical University, from January 2013 to December 2019, of whom 484 received rhGH treatment. The related anthropometrics and laboratory examinations were assessed in all participants. Results A total of 1145 children and adolescents with short stature aged 10.5 ± 3.3 years, including 740 boys and 405 girls, were analysed in this study. The number of children and adolescents with short stature gradually increased per year from 2013 to 2019. The mean pretreatment height standard deviation score (SDS) and insulin-like growth factor-1 SDS were −2.93 ± 1.05 and -1.01 (-1.83--0.16), respectively. The majority of the children (658, 57.47%) were prepubescent. In total, 484 subjects aged 10.6 ± 3.2 years received rhGH and were followed up, and among them, 292 children were treated for more than one year. As the treatment time increased, the children's height SDS gradually increased, and most of them attained a height SDS within the normal range. The mean height SDS in children who were treated for more than one year was −3.0 ± 1.0 at baseline and gradually increased to −0.8 ± 0.3 by year 6. The results were consistent across subgroups of different aetiologies of short stature. Conclusions Increasing attention has been given to the height of children during the period of 2013–2019 in eastern China. The present findings indicate that children with short stature need to be referred to a specialist centre to diagnose the cause of growth failure and that short children receiving rhGH therapy show a significant increase in height over time.
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Khadikar V, Khadilkar AV, Lohiya NN, Karguppikar MB. Extended growth charts for Indian children. J Pediatr Endocrinol Metab 2021; 34:357-362. [PMID: 33675206 DOI: 10.1515/jpem-2020-0573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/13/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES While growth charts depicting 7 percentile lines for height and weight are useful for healthcare workers and pediatricians, endocrinologists need indication-specific z score cutoffs to plan investigations and treatment. The current Indian charts do not offer lower percentile/z scores (-2.25, -2.5, and -3 z score) lines. Also, increasing prevalence of childhood overweight and obesity necessitates a quick screening of nutritional status without calculations while using the same growth chart. Our objectives were to produce extended and user-friendly growth charts for 0-18-year-old Indian children that depict -2.25, -2.5, and -3 z score height lines in addition to the standard 7 lines and to add a quick BMI assessment tool as an inset. METHODS LMS values from IAP 2015 growth charts (5-18 years) and WHO 2006 MGRS charts (<5 years) were used to generate -2.25, -2.5, and -3 z score height lines (1.2, 0.6, and 0.1 percentiles, respectively) from 0-18 year for boys and girls. These newly generated lines were added to standard 7 (3, 10, 25, 50, 75, 90, 97) percentile lines for height charts. In addition, modified BMI quick screening tool was incorporated as an inset. RESULTS The extended height charts (with 10 lines), standard (7 lines) weight charts, and quick BMI assessment tool are presented in a single unified chart for use by endocrinologists. CONCLUSIONS These charts will help in defining specific height z score cutoffs as well as screen for overweight and obesity without any calculations in Asian Indian children.
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Affiliation(s)
- Vaman Khadikar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Anuradha V Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32 Sassoon Road, 411 001, Pune, India
| | - Nikhil N Lohiya
- Pediatrics, Dr. D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Madhura B Karguppikar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
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Singh AD, Singh P, Farooqui N, Strand T, Ahuja V, Makharia GK. Prevalence of celiac disease in patients with short stature: A systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:44-54. [PMID: 32621396 DOI: 10.1111/jgh.15167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/05/2020] [Accepted: 06/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Short stature is a common extraintestinal manifestation of celiac disease (CeD). We conducted a systematic review and meta-analysis to assess the global prevalence of CeD in patients presenting with short stature. METHODS We searched Medline and EMBASE databases for the keywords "celiac disease, coeliac disease, anti-gliadin, tissue transglutaminase antibody, anti-endomysial antibody, short stature and growth retardation." All the studies published from January 1991 to May 2020 were included. Patients without any prior evaluation for short stature were classified as all-cause short stature, while prior evaluated patients, where no cause was found for short stature, were classified as idiopathic short stature. The diagnosis of CeD was based on the European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines. A random-effects model was used to pool the data. RESULTS Seventeen studies screening 3759 patients (1582 with all-cause short stature and 2177 with idiopathic short stature) were included. The pooled seroprevalence of CeD based on positive anti-tissue transglutaminase antibody and anti-endomysial antibody was 11.2% (95% CI 4.0-21.2%; I2 = 86%) and 9.7% (95% CI 2.7-20.2%; I2 = 95%) for all-cause and idiopathic short stature, respectively. Similarly, pooled prevalence of biopsy-confirmed CeD was 7.4% (95% CI 4.7-10.6%; I2 = 76%) and 11.6% (95% CI 4.1-22.2%; I2 = 97%), for all-cause and idiopathic short stature, respectively. There was an overall severe risk of selection bias and significant heterogeneity in the pooled results. CONCLUSIONS Approximately one in 14 patients with all-cause short stature and one in nine patients with idiopathic short stature had biopsy-confirmed CeD. Therefore, evaluation for CeD may be prudent in all patients with short stature.
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Affiliation(s)
- Achintya D Singh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Prashant Singh
- Department of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Naba Farooqui
- Department of Gastroenterology and Human nutrition, All India Institute of Medical Sciences, Delhi, New Delhi, India
| | - Tor Strand
- Department of Global public health, Innlandet Hospital Trust, Lillehammer, Norway
| | - Vineet Ahuja
- Department of Gastroenterology and Human nutrition, All India Institute of Medical Sciences, Delhi, New Delhi, India
| | - Govind K Makharia
- Department of Gastroenterology and Human nutrition, All India Institute of Medical Sciences, Delhi, New Delhi, India
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Bellotto E, Monasta L, Pellegrin MC, Bossini B, Tamaro G, Conte MS, Faleschini E, Barbi E, Tornese G. Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy. Front Pediatr 2020; 8:580588. [PMID: 33123505 PMCID: PMC7567164 DOI: 10.3389/fped.2020.580588] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: The knowledge of the pattern and the features of pediatric endocrinology referrals is crucial to optimize resources and guide public health interventions. We explored the numbers and the reasons for referral to a pediatric endocrinology outpatient clinic and investigated their features in terms of assignment of priority ranks, sex, age differences, the prevalence of pathological findings among referred cases, and the agreement among referrals, final diagnosis, treatment, and follow-up. Methods: Retrospective study with data collection for pediatric endocrinology first visits between November 2012 and February 2019 in a tertiary center. Results: A total of 1930 first visits were performed with an overall number of referrals of 2,165, and an increasing trend over the years. The most frequent referral reasons were slow growth, precocious puberty, and obesity; 14% of visits were classified as "urgent" (<7 days), 35% as "deferrable" (<30 days), and 51% as "planned" (<180 days). Sex and age differences among referrals were detected, with criticality in the appropriate timing for referral. Thirty-eight percent of patients had pathological findings. In 4% of the cases the final diagnosis was not concordant with the reason for referral. Treatment was prescribed in 35% of cases, and 67% returned at least for one follow-up visit. Conclusion: The study highlighted the need to target medical education of primary care on the definition of priority ranks, the need for more extended observation periods for subclinical or para-physiological conditions, the appropriate timing for referral, based on the definition of conditions or the best window of intervention.
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Affiliation(s)
| | - Lorenzo Monasta
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | - Maria Sole Conte
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Elena Faleschini
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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Quitmann J, Bloemeke J, Dörr HG, Bullinger M, Witt S, Silva N. First-year predictors of health-related quality of life changes in short-statured children treated with human growth hormone. J Endocrinol Invest 2019; 42:1067-1076. [PMID: 30840207 DOI: 10.1007/s40618-019-01027-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/20/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Little attention has been directed towards examining the impact of predictors on change in health-related quality of life (HRQOL) within the course of growth hormone (GH) treatment in pediatric short stature. We aimed to assess changes in HRQOL and its sociodemographic, clinical and psychosocial predictors in children and adolescents diagnosed with growth hormone deficiency (GHD), and born short for gestational age (SGA) before and 12-month after start of GH treatment from the parents' perspective. Results were compared with an untreated group with idiopathic short stature (ISS). In this prospective multicenter study, 152 parents of children/adolescents (aged 4-18 years) provided data on their children's HRQOL at baseline and at 12-month follow-up. METHOD Repeated-measures multivariate analyses of covariance were performed to examine parent-reported HRQOL changes from baseline to 1-year after treatment and hierarchical linear regressions to identify the predictors of HRQOL changes. RESULTS Results showed that parents of children that were treated with GH report an increase in their children's HRQOL after 1 year. Changes in HRQOL were mostly explained by psychosocial predictors followed by sociodemographic and clinical variables. Specifically, the diagnosis SGA significantly predicted a greater increase in parent-reported HRQOL. Furthermore, a lower caregiving burden significantly predicted a decrease in parent-reported HRQOL. CONCLUSION In conclusion, a substantial percentage of explained variance in HRQOL relates to psychosocial and sociodemographic predictors. However, there appears to be other important factors that are predictors of HRQOL, which need to be determined in large, population-based samples.
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Affiliation(s)
- J Quitmann
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - J Bloemeke
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - H-G Dörr
- Division Paediatric Endocrinology, Hospital for Children and Adolescents, University Erlangen-Nürnberg, Erlangen, Germany
| | - M Bullinger
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - S Witt
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - N Silva
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Faculty of Psychology and Education Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
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Wu S, Liu QQ, Gu W, Ni SN, Shi X, Zhu ZY. A Retrospective Analysis of Patients with Short Stature in the South of China between 2007 and 2015. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5732694. [PMID: 30671461 PMCID: PMC6317125 DOI: 10.1155/2018/5732694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/22/2018] [Accepted: 11/04/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the demographic features of children with short stature and poor growth in the south of China and provide better guidance on clinical strategy and decisions. STUDY DESIGN This retrospective, chart review study analyzed children with short stature and poor growth admitted to the Department of Endocrinology of Children's Hospital of Nanjing Medical University from Jan 2007 to Dec 2015. RESULTS The chart review yielded 4142 patients, including 2546 boys and 1596 girls (P < 0.001); the number of patients gradually increased per year from 2007 to 2015. There was an upward trend in the average levels of height standard deviations (SDs) during the study period (P < 0.001), both in males (P < 0.001) and females (P < 0.001). Mean height SDs were smaller in females (-2.42±1.09) than males (-2.33±1.03; P = 0.01). The percentage of females admitted at normal height (33.83%) was lower than that of males (37.20%; P = 0.028). The peak age range of hospitalization in males was 10-12 years of age, while females were generally admitted earlier-8-10 years. CONCLUSIONS There was an increasing tendency to focus on children's height. Parents and pediatricians were recommended to pay more attention to the treatment needs of girls while avoiding excessive treatment of those who merely appear not to be tall enough without a clear medical issue related to growth, especially for boys.
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Affiliation(s)
- Su Wu
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Qian-qi Liu
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Wei Gu
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Shi-ning Ni
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Xing Shi
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Zi-yang Zhu
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
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15
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Blum WF, Alherbish A, Alsagheir A, El Awwa A, Kaplan W, Koledova E, Savage MO. The growth hormone-insulin-like growth factor-I axis in the diagnosis and treatment of growth disorders. Endocr Connect 2018; 7:R212-R222. [PMID: 29724795 PMCID: PMC5987361 DOI: 10.1530/ec-18-0099] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 01/11/2023]
Abstract
The growth hormone (GH)-insulin-like growth factor (IGF)-I axis is a key endocrine mechanism regulating linear growth in children. While paediatricians have a good knowledge of GH secretion and assessment, understanding and use of measurements of the components of the IGF system are less current in clinical practice. The physiological function of this axis is to increase the anabolic cellular processes of protein synthesis and mitosis, and reduction of apoptosis, with each being regulated in the appropriate target tissue. Measurement of serum IGF-I and IGF-binding protein (IGFBP)-3 concentrations can complement assessment of GH status in the investigation of short stature and contribute to prediction of growth response during GH therapy. IGF-I monitoring during GH therapy also informs the clinician about adherence and provides a safety reference to avoid over-dosing during long-term management.
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Affiliation(s)
| | | | - Afaf Alsagheir
- King Faisal Specialist Hospital and Research CenterRiyadh, Saudi Arabia
| | - Ahmed El Awwa
- Department of Pediatric Endocrinology & DiabetesHamad Medical Center, Doha, Qatar
| | | | | | - Martin O Savage
- William Harvey Research InstituteBarts and the London School of Medicine & Dentistry, London, UK
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16
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Acerini CL, Wac K, Bang P, Lehwalder D. Optimizing Patient Management and Adherence for Children Receiving Growth Hormone. Front Endocrinol (Lausanne) 2017; 8:313. [PMID: 29209274 PMCID: PMC5701910 DOI: 10.3389/fendo.2017.00313] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/30/2017] [Indexed: 01/19/2023] Open
Abstract
Poor adherence with growth hormone (GH) therapy has been associated with worse clinical outcomes, which in children relates specifically to their linear growth and loss of quality of life. The "360° GH in Europe" meeting, held in Lisbon, Portugal, in June 2016 and funded by Merck KGaA (Germany), examined many aspects of GH diseases. The three sessions, entitled "Short Stature Diagnosis and Referral," "Optimizing Patient Management," and "Managing Transition," each benefited from three guest speaker presentations, followed by an open discussion and are reported as a manuscript, authored by the speakers. Reported here is a summary of the proceedings of the second session, which reviewed the determinants of GH therapy response, factors affecting GH therapy adherence and the development of innovative technologies to improve GH treatment in children. Response to GH therapy varies widely, particularly in regard to the underlying diagnosis, although there is little consensus on the definition of a poor response. If the growth response is seen to be less than expected, the possible reasons should be discussed with patients and their parents, including compliance with the therapy regimen. Understanding and addressing the multiple factors that influence adherence, in order to optimize GH therapy, requires a multi-disciplinary approach. Because therapy continues over many years, various healthcare professionals will be involved at different periods of the patient's journey. The role of the injection device for GH therapy, frequent monitoring of response, and patient support are all important for maintaining adherence. New injection devices are incorporating electronic technologies for automated monitoring and recording of clinically relevant information on injections. Study results are indicating that such devices can at least maintain GH adherence; however, acceptance of novel devices needs to be assessed and there remains an on-going need for innovations.
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Affiliation(s)
- Carlo L. Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Carlo L. Acerini,
| | - Katarzyna Wac
- Quality of Life Technologies Laboratory, University of Geneva, Geneva, Switzerland
| | - Peter Bang
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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