|Classification and external resources|
Short stature refers to a height of a human being which is below expected. Shortness is a vague term without a precise definition and with significant relativity to context. Because of the lack of preciseness, there is often disagreement about the degree of shortness that should be called short.
The American Association of Clinical Endocrinologists defines "short stature" as height more than 2 standard deviations below the mean for age and gender, which corresponds to the shortest 2.3% of individuals.
Shortness in children and young adults nearly always results from below-average growth in childhood, while shortness in older adults usually results from loss of height due to kyphosis of the spine or collapsed vertebrae from osteoporosis.
From a medical perspective, severe shortness can be a variation of normal, resulting from the interplay of multiple familial genes. It can also be due to one or more of many abnormal conditions, such as chronic (prolonged) hormone deficiency, malnutrition, disease of a major organ system, mistreatment, treatment with certain drugs, chromosomal deletions, inherited diseases, birth defect syndromes, bone structures fusing earlier than intended or many other causes.
Human Growth Hormone (HGH) deficiency may occur at any time during infancy or childhood, with the most obvious sign being a noticeable slowing of growth. The deficiency may be genetic.
Among children without growth hormone deficiency, short stature may be caused by Turner syndrome, chronic renal insufficiency, being small for gestational age at birth, Prader–Willi syndrome, or other conditions. When the cause is unknown, it is called idiopathic short stature.
The decision to treat is based on a belief that the child will be disabled by being extremely short as an adult, so that the risks of treatment (including sudden death) will outweigh the risks of not treating the symptom of short stature. Although short children commonly report being teased about their height, most adults who are very short are not physically or psychologically disabled by their height.
Treatment is expensive and requires many years of injections with human growth hormones. The result depends on the cause, but is typically an increase in final height of about 5 to 10 centimetres (2.0 to 3.9 in) taller than predicted. Thus, treatment takes a child who is expected to be shorter than a normal adult, and produces an adult who is still obviously shorter than average.
Increasing final height in children with short stature may be beneficial and could enhance health-related quality of life (HRQoL) outcomes barring troublesome side effects and excessive cost of treatments.
Cost of treatment
The cost of treatment depends on the amount of growth hormone given, which in turn depends on the child's weight and age. One year's worth of drugs normally costs about US $20,000 for a small child and over $50,000 for a teenager.
From a social perspective shortness can be a problem independently of the cause. In many societies there are advantages associated with taller stature and disadvantages associated with shorter stature, and vice versa.
Pharmaceutical companies Genentech and Eli Lilly, makers of human growth hormone, have worked to medicalize short stature by convincing the public that short stature is a disease rather than a natural variation in human height. Limiting sales of the hormone to children diagnosed with growth hormone deficiency, rather than being short for any reason, limited their sales market. Expanding it to all children whose height was below the third percentile would create 90,000 new customers and US $10 billion in revenue. In the early 1990s, they paid two US charities, the Human Growth Foundation and the MAGIC Foundation, to measure the height of thousands of children in schools and public places, and to send letters urging medical consultations for children whose height was deemed low. Parents and schools were not told that the charities were being paid by the drug companies to do this.
Paired with a campaign to advertise the hormone to physicians, the campaign was successful, and tens of thousands of children began receiving HGH. About half of them do not have growth hormone deficiency, and consequently benefited very little, if at all, from the hormone injections. Criticism of the universal screening program eventually resulted in its end.
- List of shortest people
- National Organization of Short Statured Adults
- Idiopathic short stature
- Growth hormone deficiency
- Psychosocial short stature
- Turner's Syndrome
- Primordial dwarfism
- "FDA Approves Humatrope for Short Stature". U.S. Food and Drug Administration. 2003-07-25. Retrieved 2009-01-13.[dead link]
- Allen DB (July 2006). "Growth hormone therapy for short stature: is the benefit worth the burden?". Pediatrics 118 (1): 343–8. doi:10.1542/peds.2006-0329. PMID 16818584.
- Brody, Howard (2007). Hooked: ethics, the medical profession, and the pharmaceutical industry. Lanham, Md: Rowman & Littlefield. p. 236. ISBN 0-7425-5218-7.
- Valenstein, Elliot S. (2002). Blaming the Brain : The Truth About Drugs and Mental Health. New York: Free Press. pp. 173–174. ISBN 0-7432-3787-0.