![]() “Everyone thinks kids on growth hormones grow more than other children, but that’s not true,” Dr. Some pediatricians and parents also are hesitant to intervene in a child’s growth pattern due to ‘tall tales’ about growth hormones. “I was always the shortest kid in my class… I call myself the advocate for all short kids.” Many tall people don’t think it’s so important to be tall, but they don’t live in short people’s shoes.” “The thing that drives me crazy is when a child is short, and a parent is short too, and the pediatrician says to the parent, ‘Well, you’re short, so what do you expect?’ Well, if the father is five-foot-two, don’t you think he’s got a problem? He’s probably growth-hormone-deficient himself. Though today’s pediatricians are more attuned to their undersized patients than ever, sometimes “they don’t understand,” Noto laments. ![]() In some cases, Noto will prescribe medication that suspends puberty, giving children a chance to grow further before their bones fuse. “Kids should grow at least two inches a year between ages three and puberty,” he says. He’ll also determine a child’s bone age - the number of years a child has left to grow - via a hand X-ray. “In addition, we assess the child’s sex hormones, to see if they will be a late developer,” Noto adds. When assessing a new patient, blood tests to check for growth-inhibiting conditions, such as celiac disease, are a must. “I call myself the advocate for all short kids.” It’s a personal mission: “I’m five-foot-four inches tall myself, and I was always the shortest kid in my class,” he recalls. For Noto, 68, it’s one of many success stories: “I’m best known for helping kids grow,” says Noto, who works at Maria Fareri Children’s Hospital, as well as Boston Children’s Health Physicians at Phelps Memorial Hospital. ![]() He prescribed injectable growth hormones.Īdam grew to 5’ 10” and in adulthood became a world champion of tae kwon do. Left untreated, “He would probably end up being five-foot-three-inches tall,” he says. An exam and diagnostic tests revealed the child was growth-hormone deficient. “He was off the growth charts, below the fifth percentile,” Noto recalls. ![]() Noto remembers the day 9-year-old Adam* visited his office, accompanied by his parents. Hospitals: Maria Fareri Children’s Hospitalĭr. We now face a very relevant clinical and social problem-should all patients with TBI be evaluated for hypopituitarism, or can we identify a subgroup of patients who must be assessed? The onset of hypopituitarism is not related to the severity of the trauma, as measured.Title: Chief of Diabetes and Endocrine Center for Children and Young Adults, Boston Children’s Health Physicians at Phelps Memorial Hospital Consequently, pituitary hormone deficiencies could result in suboptimal rehabilitation for patients with TBI-induced hypopituitarism. The signs and symptoms of postconcussion syndrome are also similar to those of panhypopituitarism or multiple-hormone hypopituitarism, and suggest that hormone deficiencies might mimic the sequelae of TBI. Postconcussion syndrome, and its signs and symptoms (headache, irritability, loss of memory, attention deficit, depression, fatigue, a low capacity for work, and cognitive alterations), are very common in the acute phase after TBI (30% of all cases). Awareness of the problem could aid appropriate screening of patients at risk, and is the first step towards the introduction of endocrinologists into the multidisciplinary team involved in the care of patients with TBI.ĭata in the scientific literature have confirmed the increased endocrine interest in TBI, as well as the need to conduct controlled studies in order to understand whether the hormone deficiency that manifests after TBI is partially responsible for the poor quality of life and outcome of these patients. It is vital, therefore, that the medical community-particularly those physicians who take care of patients in either the acute or chronic phases of TBI-are aware of this increased risk of hypopituitarism. Given the epidemiology of TBI (91-332 cases per 100,000 inhabitants worldwide) and the high risk of panhypopituitarism or hypopituitarism of multiple hormones after head trauma (10-15%), it is clear that thousands of individuals experience low quality of life, and possibly impaired life expectancy, because of undiagnosed hypopituitarism. general practitioners, endocrinologists and neurosurgeons). TBI-related hypopituitarism remains underdiagnosed, however, often because of lack of awareness among the physicians most likely to see patients who might be suffering from this condition (i.e. Indeed, the risk of TBI-related hypopituitarism is much greater than previously suspected. Author(s): Gianluca Aimaretti (corresponding author) Ezio Ghigo Įvidence from clinical studies has demonstrated that traumatic brain injury (TBI) is often the cause of hypopituitarism.
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