Guest: Deborah A. Bowlby - Pediatric Endocrinology
Host: Dr. Linda Austin – Psychiatry
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Deborah A. Bowlby, a Pediatric Endocrinologist. Dr. Bowlby, one of the most common disorders that you treat is short stature, just how common is that?
Dr. Deborah A. Bowlby: Our practice sees many patient’s for new referrals, for concerns about short stature. Often a pediatrician can flout a child’s height and weight on a growth curve. If the pediatrician notices that the child has either stop growing or is significantly shorter than would be expected based on the heights of the parents, a referral to our office is something to consider. Approximately, 3% to 5% of the population would be considered to be shorter than the normal population.
Dr. Linda Austin: So, does that translate then that if one’s child is in the fifth percentile or under that parent might consider getting an evaluation from a pediatric endocrinologist?
Dr. Deborah A. Bowlby: The first step would be to discuss that with the primary care provider. As mentioned, some of the patients who are going to be below the fifth percentile are healthy and short. They might be below the fifth percentile for height, but their parents are also short. This is something called familial short stature. If your parents are short, you might be short. Also, some children are considered late bloomers. They might be short until puberty hits. However, there certainly are a number of patients who do want an evaluation by pediatric endocrinologist.
Dr. Linda Austin: Now, if you are doing that evaluation, how do you do? What you are looking for?
Dr. Deborah A. Bowlby: So, initially we start off with the history and a key question is whether a child has stopped growing because that tells you that there may be something wrong. Our children should always continue to grow. In addition, we get a complete history and then on physical exam try to see whether we can pinpoint the area of concern.
Dr. Linda Austin: Now, when you say ‘the child has stopped growing?, for how long kids do grow in spurts, how long of a standstill would get you concerned?
Dr. Deborah A. Bowlby: If a child hasn’t grown over 6 to 12 months, that certainly would be a concern.
Dr. Linda Austin: Up until what age?
Dr. Deborah A. Bowlby: Children should continue to grow until they have completed puberty.
Dr. Linda Austin: Does that mean then that the later puberty comes on that the longer child may grow and may actually end up taller then a child who grows quickly, but has an early puberty?
Dr. Deborah A. Bowlby: Definitely and that’s why in discussing issues of growth with the child and the family, aspect of pubertal development are key
Dr. Linda Austin: Let’s imagine then that, it’s not particularly that the parents are short but that you have child, boy or girl, who has just stopped, what would do you do next? What you are concerned about?
Dr. Deborah A. Bowlby: So, the initial evaluation is first to determine if the child is healthy. Things that we are concerned about would be malnutrition, pulmonary problems, heart problems, problems with the digestive system, or rheumatologic problems with the bones and joints. That is the target of our initial evaluation. Our next step would be to assess if there is an endocrine concern.
Dr. Linda Austin: Hormones.
Dr. Deborah A. Bowlby:Exactly. So, with the hormone evaluations we look at thyroid and also growth hormone. Especially on the girls, but also in some of our male patients we assess their chromosomes to see if there are any abnormalities in the genes of these patients.
Dr. Linda Austin: So, there are some genetic problems and that show up as short stature such as what, which ones?
Dr. Deborah A. Bowlby: One of the main concerns with females would be Turner syndrome and if that is the reason for a girl to be short.
Dr. Linda Austin: How about boys?
Dr. Deborah A. Bowlby:For boys, we assess for a genetic problem if on physical exam we are concerned about a genetic syndrome.
Dr. Linda Austin: Now, what happens then, I mean obviously if there is some underlying physical problems like a thyroid problem, a lung problem, a heart problem you have treat that, but let’s imagine that all of those things check out and you just have a child who is not putting out growth hormone. What do you do then?
Dr. Deborah A. Bowlby: So, when a child comes to our office, the initial evaluation often includes a blood test and an x-ray of the left hand and wrist.
Dr. Linda Austin: Why do you x-ray the left hand and wrist?
Dr. Deborah A. Bowlby: Examination of the bones in the left hand and wrist allow you to determine a bone age. A bone age helps you determine if the child is short due to familial short stature, constitutional delay, or if there are other endocrine disturbances, which have caused their short stature. If on the initial blood test, we are concerned that the child is not making enough growth hormone, they are referred to our Day Treatment Facility where a growth hormone stimulation test is performed. Basically, it’s a fancy to our blood test.
Dr. Linda Austin: Okay, and if that comes back abnormal, what can you do to help that child?
Dr. Deborah A. Bowlby: So, if a child is found to be growth hormone deficient by blood test, we often get imaging of the brain, specifically an MRI, to assess the structure of the brain. At that point, we can consider growth hormone therapy if a patient has shown to have growth hormone deficiency.
Dr. Linda Austin: How effective is that? I mean, can you get a child then to grow to a normal size using growth hormone?
Dr. Deborah A. Bowlby: Growth hormone therapy can definitely help the patient achieve their genetic potential. If they are growth hormone deficient and without the therapy they have stopped growing or certainly had a slowdown in their growth, growth hormone will help them to grow.
Dr. Linda Austin: So, it sounds like one way or the other you can probably help the vast majority of children who have short stature, am I right about that?
Dr. Deborah A. Bowlby: Definitely, we can help patients who come to us for the evaluation of short stature. Our first job is to determine the etiology, what has caused them to become shorter then we would expect, be it a more sort of general pediatrician concern or if it’s a true endocrine concern such as the thyroid or growth hormone deficiency.
Dr. Linda Austin: Dr. Bowlby, thank you so much for talking with us today.
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