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      Causes of short stature in Pakistani children found at an Endocrine Center

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          Abstract

          Background and Objective:

          Short stature is defined as height below 3 rd centile. Causes of short stature can range from familial, endocrine disorders, chronic diseases to chromosomal disorders. Most common cause in literature being idiopathic short stature. Early detection and management of remedial disorders like malnutrition and vitamin D deficiency, Endocrine disorders like growth hormone deficiency & hypothyroidism can lead to attainment of expected height. Pakistani data shows idiopathic short stature as the most common cause of short stature. Our study aimed at detecting causes of short stature in children/adolescents at an Endocrine referral center.

          Methods:

          A retrospective study was conducted at WILCARE Center for Diabetes, Endocrinology & Metabolism, Lahore on 70 well-nourished children/adolescents. The patients had been evaluated clinically, biochemically and radiologically as needed. Biochemical testing included hormonal testing as well to detect endocrine causes. Data was entered and analyzed in SPSS 20.0.

          Results:

          Leading cause of short stature in our population was Growth Hormone (GH) deficiency seen in 48 out of 70 (69%) patients. Second most common endocrine abnormality seen in these patients was Vitamin D deficiency [44 out of 70 patients (63%)]. Primary hypothyroidism; pan-hypopituitarism & adrenal insufficiency were other endocrine causes. The weight for age was below 3 rd percentile in 57 (81%) patients, with no association with other major causes.

          Conclusion:

          Growth hormone and Vitamin D deficiency constitute one of the major causes of short stature among well-nourished children with short stature in Pakistan.

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          Most cited references34

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          Prevalence and correlates of vitamin D deficiency in US adults.

          Mounting evidence suggests that vitamin D deficiency could be linked to several chronic diseases, including cardiovascular disease and cancer. The purpose of this study was to examine the prevalence of vitamin D deficiency and its correlates to test the hypothesis that vitamin D deficiency was common in the US population, especially in certain minority groups. The National Health and Nutrition Examination Survey 2005 to 2006 data were analyzed for vitamin D levels in adult participants (N = 4495). Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D concentrations ≤20 ng/mL (50 nmol/L). The overall prevalence rate of vitamin D deficiency was 41.6%, with the highest rate seen in blacks (82.1%), followed by Hispanics (69.2%). Vitamin D deficiency was significantly more common among those who had no college education, were obese, with a poor health status, hypertension, low high-density lipoprotein cholesterol level, or not consuming milk daily (all P < .001). Multivariate analyses showed that being from a non-white race, not college educated, obese, having low high-density lipoprotein cholesterol, poor health, and no daily milk consumption were all significantly, independently associated with vitamin D deficiency (all P < .05). In summary, vitamin D deficiency was common in the US population, especially among blacks and Hispanics. Given that vitamin D deficiency is linked to some of the important risk factors of leading causes of death in the United States, it is important that health professionals are aware of this connection and offer dietary and other intervention strategies to correct vitamin D deficiency, especially in minority groups. Copyright © 2011 Elsevier Inc. All rights reserved.
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            Utah Growth Study: growth standards and the prevalence of growth hormone deficiency.

            Serial measurements of elementary-school children were conducted for 2 consecutive years to assess height and growth velocity and to determine the prevalence of growth hormone deficiency (GHD) in American children. Trained volunteers measured 114,881 children the first year; 79,495 growth rates were calculated after the second measurements. The height and growth velocity curves generated were very similar to the currently used charts. We examined 555 children with short stature (< 3rd percentile) and poor growth rates (< 5 cm/yr). Five percent had an endocrine disorder. The presence of GHD (peak level, < 10 ng/dl with two provocative tests) was found in 16 previously unrecognized children; 17 children from this school population were already known to have GHD. Boys outnumbered girls 2.7:1 (p = 0.006). Six girls with Turner syndrome also were identified. We conclude that (1) the growth curves generated in the 1960s and 1970s are valid for children of the 1990s; (2) most children growing < 5 cm/yr (a commonly used threshold rate) will not have an endocrine disorder; (3) many children (48% in this study) with GHD and others with Turner syndrome may currently be unrecognized and untreated; (4) GHD appears to be more common in boys; and (5) the prevalence of GHD in the United States is at least 1:3480.
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              Growth curve for girls with Turner syndrome.

              A growth chart for girls with Turner syndrome has been prepared using data from four published series of European patients, and evaluated using retrospective data on the heights of girls with Turner syndrome seen at this hospital. The results indicate that calculation of height standard deviation score from this chart allows a reasonable prediction of adult stature in any patient with Turner syndrome. In addition, the results indicate that while oestrogen treatment causes an initial acceleration of growth, it has no significant effect on adult height.
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                Author and article information

                Journal
                Pak J Med Sci
                Pak J Med Sci
                Pakistan Journal of Medical Sciences
                Professional Medical Publications (Pakistan )
                1682-024X
                1681-715X
                Nov-Dec 2016
                : 32
                : 6
                : 1321-1325
                Affiliations
                [1 ]Prof. Ali Jawa, MD, MPH, DABIM, FACE, Wilshire Cardiovascular and Endocrine Center of Excellence (WILCARE), Lahore, Pakistan, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS, Islamabad, Pakistan
                [2 ]Syed Hunain Riaz, FCPS (MED), Wilshire Cardiovascular and Endocrine Center of Excellence (WILCARE), Lahore, Pakistan
                [3 ]Muhammad Zaman Khan Assir, FCPS (MED), Wilshire Cardiovascular and Endocrine Center of Excellence (WILCARE), Lahore, Pakistan
                [4 ]Bahjat Afreen, FCPS (MED), Wilshire Cardiovascular and Endocrine Center of Excellence (WILCARE), Lahore, Pakistan
                [5 ]Amna Riaz, FCPS (MED), FCPS (ENDO), Wilshire Cardiovascular and Endocrine Center of Excellence (WILCARE), Lahore, Pakistan
                [6 ]Prof. Javed Akram, MD, MRCP, FRCP (GLASG), FACP, FACC, FASIM, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS, Islamabad, Pakistan
                Author notes
                Correspondence: Dr. Syed Hunain Riaz, MBBS, FCPS. 4-5 M, Model Town Extension, Maulana Abul Hasan Isphahani, Main Faisal Town, Boulevard, Lahore, Pakistan. E-mail: syedhunain@ 123456gmail.com
                Article
                PJMS-32-1321
                10.12669/pjms.326.11077
                5216274
                28083018
                d136b9ed-03dd-4587-ad58-d408aeb2ce59
                Copyright: © Pakistan Journal of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 July 2016
                : 09 September 2016
                : 25 September 2016
                Categories
                Original Article

                children,growth hormone deficiency,hypothyroidism,pakistani,short stature,vitamin d deficiency

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