Pediatric Annals


Short Stuff

Stanford T Shulman, MD


Modern research has led to increased knowledge surrounding the causes and treatments of short stature.


Modern research has led to increased knowledge surrounding the causes and treatments of short stature.

I vividly recall one of the first new pediatrie outpatient clinic patients I encountered as a firstyear pediatrie resident some 35 or so years ago. The patient was a 5-yearold girl who was quite short and who, to my amazement, had the characteristic physical findings (once I found out what to look for) of Turner syndrome. As I recall, there was little to do for her at that time except offer counseling, because little real information was available about this condition.

In this issue of Pediatric Annals, Dr. Donald Zimmerman and his colleagues cover a range of topics that relate to children with short stature, including a comprehensive review on Turner syndrome. This article presents a great deal of information related to this most interesting syndrome. In keeping with a common phenomenon, Turner was the second (after Ullrich) to describe the syndrome and, probably because of a better public relations consultant, had bis name rather than Ullrich's forever attached to this condition.

Also included here are reviews that focus on the evaluation of short stature, the indications for and side effects associated with growth hormone therapy, and the conditions known collectively as idiopathic short stature, which cannot at this time be split apart by biochemical criteria.

Taken together, this collection of articles promises to provide pediatrie providers with guidance and insight regarding the child with short stature and the roles of growth hormone and insulinlike growth factors.

Because the endocrinologist's first tool to evaluate short stature is the growth chart, I have chosen three stamps that include infant growth charts in their design. In the spirit of full disclosure, I should point out that, on these colorful stamps from Nicaragua, SL Vincent, and the Central African Republic, the charts appear to represent weights rather than heights.

The fourth stamp is from Romania and honors Nicolas C. Paulesco (1869-1931), who is identified on the stamp as the discoverer of insulin. Paulesco was a Romanian who received his medical training in Paris and also studied biochemistry and physiology at the Sorbonne in Paris. He pioneered the field of experimental physiology involving the endocrine glands and, after returning to Romania, was the first to show that removal of the anterior lobe of the pituitary (but not the posterior) was fatal.

He subsequently tried to isolate the actively secreted substance of the pancreas that lowered blood sugar. Even though his work was interrupted from 1916-1920 by World War I, he published his work in August 1921 that showed that he had isolated a pancreatic anti-diabetic hormone capable of lowering blood sugar in diabetic and normal dogs, calling it pancreine. The Canandians Banting and Best, who were completely unaware of Paulesco's success, reached identical conclusions, published in 1922. In 1923, the Nobel Prize in Medicine was awarded to Banting and J.R- Macleod of Toronto, overlooking Best as well as Paulesco, woo actually had crossed the finish Une first.


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