Focus

There are a variety of different causes of growth disorders, which require differential diagnostic clarification to enable us to help the affected children and adolescents.

Causes of hyposomie can on one hand come from chronic diseases or be the result of hormone disorders. These include a deficiency in the growth hormone, puberty disorders or diseases of the thyroid or adrenal gland. But not every case of hyposomie can be traced to a primarily disease. There is often "simply" a retardation in development. As a diagnosis by exclusion is required, it is always necessary to monitor the speed of growth.

It is also important to examine children at the age of four, who were born too small and too light for their gestational age (SGA children). The children, who don’t make up for the growth difference, benefit greatly from growth hormone treatment within the course of the SGA indication.

Please observe: Hyposomie is a relative term and can only be detected in relation to growth percentiles and with regard to the calculated target figure area.

In the case of children, who are conspicuously tall for their age, the left hand should be examined using an x-ray image to determine whether there is an acceleration in development or if the prospective final height lies within the calculated target figure area. Early recognition of hormonal development acceleration is important for an acceptable final height in adult years.

If the parents are tall, macrosomie from family disposition, the possibility of growth inhibiting hormone therapy can be explored in an endocrinological consultation talk when the patient has reached a height of 160-170 cm, if the growth prognosis for boys lies above 203 cm or above 187 cm for girls.

Macrosomie can however derive from genetic syndromes such as Klinefelter’s or Marfan syndrome. In such cases diagnostics and therapy can be provided from one source in cooperation with the consultants for human genetics from the MVZ Dr. Eberhard & Partner.

Eating disorders can be caused by metabolic diseases as well as by psychological factors. In addition to behavioural therapeutic and psychotherapeutic approaches endocrinological clarification could be advisable.

The percentage of obese and adipose children and adolescents is growing continuously. A growing number of people suffer from secondary diseases such as diabetes mellitus type 2, high blood pressure, and metabolic disorders. We regularly diagnose a metabolic syndrome even in childhood years.

Only in very rare cases is the cause of the overweight a hormonal disease, for example an under-active thyroid gland. However all obese children and adolescents should be examined for primary disease or established secondary diseases.

Consultation talks reveal the cause of the obesity. We work with both parents and children on solutions and their long-term implementation.

Should symptoms of hyperactivity be apparent the resident paediatrician can perform laboratory medical tests on the patient to check for a hyper function of the thyroid gland (hyperthyreose). Should the tests indicate Morbus Basedow, the child/adolescent should immediately be referred to the paediatric endocrinologists.

The thyroid gland function is often examined when the patient has adipositas to eliminate an under-active function (Hypothroidism) as the cause of the obesity. The incidence of autoimmune thyroiditis is continually increasing. In the case of J1 the thyroid gland auto antibodies (TPO-AN) and the thyroid gland values should be examined for every case.

The most common adrenal gland disease is adrenogenital syndrome (AGS). Several federal states carry out screening for increased 21-hydroxylase-values. But there are still children, who have late-onset-AGS, and remain undiagnosed. These cases become apparent through development acceleration, premature pubarche, increased hair growth or irregular periods.

If there is insufficient production of cortisol Addison’s disease can develop. This should be taken into consideration if the patient displays signs of extreme tiredness, loss of weight or browning without sunlight. Overproduction of cortisol leads to obesity.

Hormonal malfunctions, vision disorders, large amounts of water excretion, scotoma, severe recurring headaches, development delays, hyposomie, performance deterioration, vomiting can all be indications of a disease in the hypophyse sector. Organic causes must be eliminated.

There is a distinction between early and late puberty developments. If for example there is development of secondary sexual characteristics in girls before their 8th birthday and boys before their 9th birthday a diagnostic clarification should be conducted.

Further diagnostics are also necessary if puberty fails to appear by the age of 13 for girls and 14 for boys. The diagnostics clarify the cause of the delay and enable the patient to take countermeasures as applicable. If there is no primary disease puberty induction can be considered.

Malformation of the inner and outer genitals can also have diverse causes. The differential diagnosis necessitates both genetic and endocrinological analytics to distinguish chromosomal aberrations from malformations stemming from anatomic, gonadal and hormonal origins.

Boys and girls acknowledge increasingly more often that they are living in the wrong body and want to change sex. After clarifying organic causes we can point out legal and medical possibilities in the course of consultation talks.