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a bFig. 1.18 Midline defects in patients with hypopituitarism, (a) bifid uvula, (b) single central
incisor
- How to suspect growth hormone deficiency in a prepubertal child?
GHD should be suspected in a short child with severe short stature (<−3SD),
height <−2SD with height velocity <−1SD over 1 year, or height velocity <−2SD
over 1 year. The phenotypic features which suggest a diagnosis of GHD in a short
child include prominent forehead, depressed nasal bridge, midfacial hypoplasia,
facial immaturity, chubby face, delayed dentition, tardy nail growth, micropenis,
and overweight for height. History of breech presentation, presence of nystag-
mus, or midline abnormalities like cleft lip, cleft palate, or single central incisor
and bifid uvula in a short child should also raise a suspicion of GHD. In addition,
a child with known sellar–suprasellar pathology or having other anterior pituitary
hormone deficiencies should also be evaluated for GHD (Fig. 1.18a, b).- What are the endocrine complications associated with breech delivery?
Breech delivery is associated with a risk of injury to pituitary, adrenal, and
testes. Injury to the pituitary stalk during breech delivery may manifest later as
isolated growth hormone deficiency or multiple pituitary hormone deficiency.
However, the cause and effect relationship between breech delivery and hypo-
pituitarism is not well established. In addition, breech delivery may be associ-
ated with adrenal hemorrhage (with adrenal insufficiency) and torsion testes.- What are the causes of GHD?
The most common cause of short stature is familial. GHD accounts for approxi-
mately 15 % of children with short stature and may be isolated or associated
with multiple pituitary hormone deficiencies. However, isolated GHD in major-
ity of children is idiopathic. The causes of GHD are shown in the figure given
below (Figs. 1.19, 1.20, and 1.21).1 Disorders of Growth and Development: Clinical Perspectives