[Growth disorders. Recommendations for a practice-oriented classification].

Abstract

Besides acute illnesses, including allergies, growth disturbances are among the most frequent reasons for parents to consult a physician about their children. The basis of diagnosis is a detailed family and personal history. Actual measurement of the parents is necessary for calculation of the patient's target height. The growth data obtained must be charted on percentile curves. Only in the second line of the diagnostic approach should the physician resort to hormone determinations and X-rays of the left hand and wrist for bone age determination. For practical purposes, growth aberrations may be subdivided into normal variants and pathologic processes. The latter may cause proportionate or disproportionate disturbances. For therapeutic reasons it is also important to know whether the deviation of growth started pre- or postnatally. Many growth disorders that develop postnatally are amenable to therapy. They include the following endocrinopathies associated with short stature: isolated growth hormone deficiency (treatment with hGH), congenital adrenal hyperplasia due to enzyme deficiencies (treatment by replacement of cortisol), idiopathic, iso-sexual precocious puberty (treatment with LHRH agonists), and hypothyroidism (treatment with thyroxine). Patients with Turner syndrome benefit from sex hormones only insofar as secondary sexual characteristics develop: these agents do not promote overall growth. The treatment of patients with tall stature by administration of estrogens/gestagens in high dosages is viewed with increasing scepticism. On the average, only a 4-cm reduction in length can be achieved if patients are treated from the onset of puberty through a bone age of 16 years. All secondary growth disturbances are improved by efficient treatment of the primary, underlying disease entity.