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Child - growth retardation

Q: My son Harsh is 12 years 6 months old, short statured boy with a height of 1.33 metre and weight of only 24 kgs. I had consulted one Endocrinologist who advised the following tests with respective results:
Serum Free T4:1.9 mg/dl, Serum TSH 3.7 mcu/ml, Serum Growth Hormone: 3.2 mg/ml, Serum 17 Beta Oestradiol: 47.8 pg/ml, Sugar(F): 69.00 mg/dl, Urea 39.00 mg/dl, Haemoglobin: 1.6g%, Total Leucocytic Count 5100cu/mm, Neutrophil: 46%, Lymph:51%, Mono 1%, Eosinophil 2%, Basophil 0%, ESR (First hour) 12 mm.

I am worried about his poor health. Kindly send me your valuable medical advice.

A:Your son, Harsh is grossly underweight and short for his age. It is not clear from the history whether Harsh is short since birth and has been growing at a rate similar to or below normal children at different ages. It is also important to know whether he has started developing signs of puberty as he is now more than 12 years old. It is also important to know whether the parents are also short and whether he has any signs and symptoms of a genetic disorder responsible for short staure anr poor weight gain.

The investigations provided essentially show a normal thyroid function, normal biochemical and haematological profile. Estimation of Growth hormone (GH) levels in a single sample does not help to diagnose GH deficiency. It is not clear why the estradiol level was done in a boy.

I suggest the following to decide further course of action:
1. Growth records: If the child is growing at a rate less than 5 cm/year and at level much less than midparental height, he needs more specific hormonal studies.
2. Estimation of bone age: This is generally done by x-ray of hand and wrist. If the bone age is less than chronological age, he needs further evaluation for a hormonal etiology.
3. Assessment of puberty: If he has no signs of puberty as yet, it is possible that he has multiple pituitary hormone deficiencies.
4. If the growth velocity is indeed low throughout, he needs a GH stimulation test with either clonidine or insulin in a center where facilities are available.
5. Till such studies are done, the help of a pediatrician and a dietician should be sought to correct any underlying nutritional deficiencies and diagnose possible genetic syndromes.


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