Insufficiency of the anterior pituitary gland , which arose in childhood .Pituitary dwarfism , pituitary microsomia
Endocrinology / / August 12, 2017
diagnosis of pituitary dwarfism in adults is not difficult.Proportional figure for a small increase, expressed delayed sexual development, the absence of mental retardation provide sufficient grounds for the diagnosis.
Children diagnosed with pituitary dwarfism is made by progressing pronounced lag growth and skeletal maturation, lack of sexual development, and is particularly significant in the case of clinical and laboratory signs of failure of the thyroid gland (bradycardia, dry skin, low levels of protein-bound iodine in the blood,hypercholesterolemia) and adrenal cortex (hypotension, hypoglycemia, decreased tolerance to water stress, low urine excretion 17-keto steroids and 17 glucocorticoids, decreased pituitary adrenocorticotropic reserves, identify the sample with the SU-4885).
Children need to carry out a differential diagnosis between pituitary and "primary" or "not endocrine" dwarfism.This form of stunting, apparently due to genetically occurs in some nations (pygmies), and in rare cases oc
great difficulties is unlike gipopituitarnyh dwarfs from children with constitutionally delayed growth and physical development.This form of disease is the most common cause of small stature in children (according to 45% of all children with a delay of growth) and is characterized by delayed physical development of a child, but only a few timely or delayed puberty.In adolescence, these children begin to grow rapidly and reach a normal growth.Children with constitutionally slow growth, as well as in gipopituitarnyh dwarfs not only lags behind the growth, but also the maturation of the skeleton does not correspond to the age and growth.However, if the pituitary dwarfs the gap between age and physical development of progressive increases in children with constitutionally slow growth of the interval between the true age and "bone" age varies little over the years, and they are rarely so stunted as gipopituitarnye dwarfs.Children with detection of radiological signs of epiphyseal dysgenesis make it easy to distinguish children with growth retardation in connection with primary hypothyroidism from gipopituitarnyh dwarfs.
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Differential Diagnosisgipopituitarnyh dwarfs and patients chondrodystrophy also not difficult.For Chondrodystrophy characterized by degenerative changes in the epiphyseal cartilage, preventing the growth of long bones.Thus there is a disproportionate skeletal development: the limbs are very short, while the body length and head size normal or near normal.Symptoms of thyroid disease, adrenal cortex and gonads in patients Chondrodystrophy absent.
There are "primary" dwarfs, who, along with growth retardation, there are a number of congenital anomalies of the skeleton development - craniofacial dysostosis (hypoplasia of the facial portion of the skull with a relatively large brain parts), various other congenital malformations, often - delayed mental development.The differential diagnosis of these forms of dwarfism and pituitary dwarfism, in which there are no congenital malformations and mental development lag, usually is not difficult.
Less may be required in the differential diagnosis between pituitary dwarfism and gonadal agenesis (Shereshevskii syndrome - Turner).Patients Shereshevsky - Turner syndrome reach growth of about 140 cm This disease is characterized by distinctive clinical picture -. Stocky physique, presence of wing skin folds, etc. (see "Disorders of sexual differentiation" section.)..
Stunting in children may be associated with the elementary factors - poor or malnutrition, as well as various metabolic diseases and chronic diseases of internal organs - kidneys, heart, lungs, digestive system, that must be considered when establishing the diagnosis of pituitary dwarfism.