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Pituitary Dwarfism

more about Pituitary Dwarfism

Growth hormone deficiency

  • A child who is destined to become a dwarf, has growth hormone deficiency.  There are 2 types of dwarfs.  The pituitary dwarf has too little growth hormone.  The achondroplastic dwarf has an orthopedic reason for having short limbs and a short spinal colum.  The pituitary dwarf lacks growth hormone (an endocrine reason).  The discussion below, refers to pituitary dwarfs.
  • These children usually appear normal at birth, with a normal length and weight.
  • The major influence of growth hormone (on a child's growth) occurs after the child is six to twelve months old, so the child's growth in height and weight may be normal from birth up to the age when large amounts of growth hormone are needed.
  • Growth hormone is one of the many hormones produced by the front part of the pituitary gland (a gland at the base of the skull).  After the hormone is made, it is secreted into the bloodstream, to affect many parts of the body.
  • A section of the brain called the hypothalamus sends a messenger substance to the pituitary gland, telling it to produce growth hormone.  Another messenger substance tells the pituitary to stop producing growth hormone.

  • Dwarfism
  • In growth hormone deficiency, Low Blood Sugar can occur, because the action of insulin is not opposed by the normal amount of growth hormone.
  • Growth hormone deficiency might be an isolated deficiency, or a patient might lack other pituitary hormones as well.  If many of these hormones are lacking, there are often neurologic signs, eye signs, vision impairment, Low Blood Sugar, and short stature.  The Low Blood Sugar occurs when the action of insulin is unopposed; or minimally opposed because of deficiency of pituitary hormones.

  • Mostly unknown
  • Rarely, a tumor or cyst in the pituitary area

  • Growth hormone is not released into the blood stream evenly throughout the day.  The highest levels in the blood occur after deep sleep.  This makes it hard to test the highest level of hormone that a child is able to produce, (since the measurement would have to be made at night, during deep sleep) and thus it is hard to prove that the child has growth hormone deficiency.
  • If a growth hormone level is drawn at night, during deep sleep, and is normal, it goes against growth hormone deficiency.  However, if there is strong suspicion of this diagnosis, other tests can be used to stimulate the release of growth hormone (and to see if the body can produce a satisfactory level of growth hormone).
  • If one measures a low level of growth hormone in the blood during a daytime blood test, this might not be helpful in diagnosing growth hormone deficiency.  This is because the level is low in the daytime, anyway.
  • Growth hormone raises the level of blood sugar (glucose) when blood sugar is low.  So do most other hormones.  Insulin, of course, lowers blood sugar.  This is the basis of one of the tests that formerly was often used to measure the pituitary's ability to produce growth hormone.  If insulin were used to lower the blood sugar, then growth hormone would be released into the bloodstream to raise blood sugar, and the level of growth hormone could be measured.  The test is not often used nowadays, because a dangerously Low Blood Sugar could occur during the test.  Other medications can be used to provoke the release of growth hormone into the bloodstream.
  • Heavy exercise causes release of growth hormone, and is another way to obtain a growth hormone level in testing for deficiency.
  • The growth hormone blood test may need to be done several times, (stimulating the release of growth hormone with medication each time) in order to tell if the child is able to produce the normal amount of growth hormone.

  • Disease of the hypothalamus of the brain
  • Disease of the front of the pituitary gland in the brain
  • Newborns who had some type of serious medical event (such as a lack of oxygen) happen in the perinatal period, are at risk for the type of growth hormone deficiency caused by damage to the hypothalamus.  The perinatal period is labor, delivery, and the first few days as a newborn.  If the hypothalamus is damaged, a messenger from the hypothalamus does not get sent to the pituitary, telling the pituitary to make growth hormone.  Therefore, the pituitary makes very little GH.

  • Treatment with human growth hormone theoretically corrects the deficiency, but is most successful when the child is young.  It must be given by injection.  Growth hormone from animals is not suitable.
  • Growth hormone for injection is produced artificially in the laboratory.

  • Short stature, as mentioned
  • Complications of the growth hormone injections, such as headache and vision changes due to high pressure in the brain (intracranial hypertension).
  • Growth hormone injections could possibly worsen diabetes.

  • There is a picture-graph that physicians keep, showing the child's height and weight at various ages.  The line showing the height or weight will normally look like a curve, having a generally-upward trend, both for height and for weight.  Parents should ask the physician to try and find an explanation if the child is falling-off the curve for height or weight.
  • If the height or weight of the child remains constant while the child's friends of the same age are increasing in height and weight, parents should bring this to the attention of their physician.
  • If a child had a serious medical event happen during the mother's labor, delivery, or the first few days of the baby's life, and subsequently is not gaining height or weight normally, the parents might bring it to the attention of the physician, and question whether their child may be exhibiting growth hormone deficiency.

  • Prader Willi syndrome is an obesity condition that also has growth hormone deficiency.
  • Panhypopituitarism is a condition in which not only growth hormone but also other hormones of the front of the pituitary are deficient,
  • Short stature has many other causes that have nothing to do with growth hormone deficiency (as far as is known), such as genetic tendency, being malnourished, and chronic disease.

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