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This is due to GH-independent, insulin-mediated IGF1 generation and enhanced GH sensitivity because of upregulation of GH receptors, as evidenced by increase in GH-­ binding proteins (GHBP). 18. A 6-year-old obese child presented with short stature. Is it of concern? Childhood obesity is associated with normal/accelerated height velocity. Therefore, presence of short stature in an obese child is almost always pathological and should be evaluated further. The common causes of short stature with obesity include Cushing’s syndrome, hypothyroidism, isolated growth hormone deficiency, pseudohypoparathyroidism, and Prader–Willi syndrome.

What is intrinsic short stature? Intrinsic short stature is associated with disorders which are characterized by inherent limitation of bone growth. 13). 1 Disorders of Growth and Development: Clinical Perspectives 29 Fig. 13 Intrinsic short stature due to achondroplasia in siblings 41. What is idiopathic short stature? Idiopathic short stature (ISS) is defined as height 2SD below the mean for age and gender of corresponding population without any evidence of chronic systemic illness or chromosomal, psychosocial, or endocrine disorders.

16. Why do obese children have higher growth velocity despite low GH? Obesity in childhood and adolescence is associated with increased height velocity with low basal as well as stimulated GH levels, normal total IGF1, and increased “free” IGF1. Obesity-induced hyperinsulinemia promotes GH-­independent IGF1 generation, increases free IGF1 level by reducing IGFBP1, and directly stimulates IGF1 receptor, thereby resulting in accelerated linear growth. Elevated levels of “free” IGF1 increase somatostatin tone, resulting in decreased GH secretion.

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Endocrinologia


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