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Medically underserved girls evaluated for short stature less often
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Primary care physicians are less likely to refer short girls for diagnostic testing that can uncover underlying medical reasons for their short stature than short boys, according to results of a study that examined an urban pediatric population in Philadelphia.
Girls with medical conditions causing their short stature, such as growth hormone deficiency and Turner’s syndrome, may go undiagnosed or may be diagnosed later than boys, limiting timely treatment, researchers said.
“We found that growth faltering is common in urban, largely minority, underserved pediatric practices,” Adda Grimberg, MD, a pediatric endocrinologist at The Children’s Hospital of Philadelphia, said in a press release.
Grimberg and colleagues analyzed referral patterns for growth faltering in a retrospective study of more than 33,000 children aged 6 months to 20 years, most of whom were black. Of the children studied, 3,007 had growth faltering (53% boys). Growth faltering was defined as being in the lowest 5% of height for the child’s age and sex, or by a standardized measure of growth deceleration. Children with growth faltering had more diagnostic tests than other children in the study, and boys were more likely to be tested for deficiencies of the GH system than girls.
Results revealed that most children with growth faltering were managed by PCPs, rather than subspecialists such as endocrinologists or gastroenterologists.
“Only 8% of the children with growth faltering received subspecialist care, and there is a gender and race disparity that is not beneficial to the children who may need additional treatment,” Grimberg said.
The children who visited subspecialists tended to have greater deficits in stature and were seen more frequently by PCPs compared with children not referred to specialists. Children who saw endocrinologists were aged 2 to 3 years older than children who did not receive subspecialist care, whereas children who saw gastroenterologists were about the same age as children who were not referred to subspecialists. In addition, black children were less likely to see a subspecialist vs. white children, and the disparity was greater for endocrinology than gastroenterology. Subspecialty care was not associated with sex or insurance type.
Only 1% of the girls with growth faltering received chromosome testing. Girls were more likely to have this test than boys because Turner’s syndrome is a genetic condition that leads to a reduction in height and occurs in girls only. Thirty-five percent of the girls tested were aged 12 years or older.
“Timely diagnosis is important for the initiation of proper monitoring and treatment of syndrome-associated complications such as renal and cardiac malformations, neurosensory hearing loss and neurocognitive issues. It is particularly concerning that 35% of the girls with growth faltering and chromosome testing were already at least 12 years old,” Grimberg said.
“While social pressures for tallness may be greater in boys than girls, primary care providers who overlook growth faltering may be missing out on an underlying condition that has additional health consequences. Height is the clue, not the endgame,” she said.
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Disclosure: The researchers report no relevant financial disclosures.
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