Endocrinal related growth disorders

Children on GH therapy should be followed–up by checking height SDS, growth velocity SDS, complications of therapy and injection technique every 3 months and free thyroxine ,blood sugar, HbAIC, IGF-I and IGFBP-3 annually.GH therapy is associated with significant improvement in growth velocity during the first two years of treatment later on, growth at a normal rate occurs following correction of GH deficient state.High doses of GH during puberty (0.7 mg/kg/week) was associated with significantly higher growth velocity compared to lower doses. Early diagnosis, higher dose, higher target height SDS, greater height SDS at the time of onset of puberty and longer duration of therapy are associated with better outcome with GH treatment.A recent analysis demonstrated the overall safety of rhGH for the treatment of various pediatric growth disorders .However constant surveillance for rare but important associated events must continue.Tall stature, another growth disorder, is more accepted in the society than short stature ,and less frequently a reason for seeking medical attention .However it may be due to a pathological cause or a part of a clinical syndrome.Pituitary gigantism is caused by excessive GH secretion before fusion of the epiphysis, while acromegaly occurs after their fusion. The possibility of pathologic growth should be considered in all individuals who exceed mean normal height by 3 SD. Most patients with gigantism have pituitary macroadenomas with extrasellar extension. Trans-sphenoidal surgery is indicated in order to debulk or totally remove the tumor.