eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Growth Failure: Follow-up

Author: Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Coauthor(s): Neslihan Gungor, MD, Instructor, Department of Pediatrics, Section of Endocrinology, Children's Hospital of Pittsburgh and University of Pittsburgh
Contributor Information and Disclosures

Updated: Sep 15, 2009

Follow-up

Further Outpatient Care

  • While the cause of growth failure is being investigated, most practitioners prefer to reevaluate patients at intervals of 3 months. This amount of time also permits repeated growth measurements, which then allows an estimation of growth velocity.

Prognosis

  • Prognosis for adult stature depends on the cause of the growth failure. Initiating therapeutic intervention is important before the patient has closure of the epiphyses with the concomitant finishing of the growth process. If a diagnosis of hypothyroidism or growth hormone (GH) deficiency is made, replacement of the deficient hormone usually results in a period of rapid catch-up growth, with subsequent normal growth until epiphyseal fusion.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • The most significant medicolegal pitfall is overlooking a CNS tumor with growth failure as its manifestation. Although CNS tumors also often produce neurological symptoms, such as headache with nausea and vomiting or visual changes, 10% of children diagnosed with craniopharyngioma present with growth failure as the only symptom. Importantly, these children are presenting with growth failure (a slow growth velocity) and not just short stature.
  • Delayed diagnosis of a treatable cause of growth failure is another pitfall. Once the epiphyses are fused, correction of the cause of the growth failure does not result in further growth.

Special Concerns

  • Children with short stature are frequently teased. Western culture is more accepting of short stature in girls than in boys, a concept that is imbedded in the language. Short girls are often described as petite or cute, whereas terms used to describe short boys are more often pejorative. Studies of children with growth hormone deficiency have shown that these children tend to have normal intelligence but demonstrate poor school performance. They also tend to have more abnormalities on the child behavior checklist. Growth hormone therapy results in improvement.
 


More on Growth Failure

Overview: Growth Failure
Differential Diagnoses & Workup: Growth Failure
Treatment & Medication: Growth Failure
Follow-up: Growth Failure
Multimedia: Growth Failure
References
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References

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  8. Hintz RL. Disorders of growth. In: Brunwald E, Fauci AS, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 13th ed. New York, NY: McGraw-Hill Medical Publishing Division; 1994.

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Further Reading

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Keywords

slow growth velocity, short stature, growth hormone, GH, GH secretion, growth hormone–releasing hormone, GHRH, growth hormone–releasing peptide, GHRP, ghrelin, growth deficiency, GH deficiency, delayed puberty, slow growth velocity, idiopathic short stature, ISS, growth failure, familial short stature, constitutional delay, Gh deficiency, Turner syndrome, hypothyroidism, Down syndrome, cystic fibrosis, chronic renal insufficiency, juvenile rheumatoid arthritis, Hurler syndrome, intrauterine growth retardation, Noonan syndrome, Russell-Silver syndrome, skeletal dysplasia, microcephaly, cyanotic heart disease, gluten enteropathy, ulcerative colitis, Crohn disease, inflammatory bowel disease, renal tubular acidosis, dermatomyositis, psychosocial dwarfism, Prader-Willi syndrome, fetal alcohol syndrome, placental insufficiency syndrome, achondroplasia, hypochondroplasia, thyroid hormone deficiency, Laron dwarfism, Cushing syndrome, Cushing disease, androgen excess, treatment, diagnosis

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Contributor Information and Disclosures

Author

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfizer, Inc. Honoraria Consulting

Coauthor(s)

Neslihan Gungor, MD, Instructor, Department of Pediatrics, Section of Endocrinology, Children's Hospital of Pittsburgh and University of Pittsburgh
Neslihan Gungor, MD is a member of the following medical societies: American Academy of Pediatrics and American Association of Clinical Endocrinologists
Disclosure: Nothing to disclose.

Medical Editor

Thomas A Wilson, MD, Professor of Clinical Pediatrics, Department of Pediatrics; Director of Pediatric Endocrinology, Division of Pediatric Endocrinology, Department of Pediatrics, State University of New York at Stony Brook
Thomas A Wilson, MD is a member of the following medical societies: Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London), Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece
George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Bruce Buehler, MD, Professor of Genetics, Munroe Meyer Institute, Professor, Department of Pediatrics, Pathology and Microbiology, University of Nebraska Medical Center
Bruce Buehler, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Pediatrics, American Association on Mental Retardation, American College of Medical Genetics, American College of Physician Executives, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

 
 
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