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For 20 years, KIGS (Pfizer International Growth Database) has provided an outstanding tool for monitoring the use, efficacy and safety of growth hormone (GH) treatment in children with short stature of varying origin. This volume offers a comprehensive update of the continuing experiences in KIGS and is based on data from more than 50 countries and more than 60,000 patients. International experts analyse in detail the basic auxological characteristics of patients and their response to GH treatment for a broad spectrum of growth disorders. These include idiopathic GH deficiency, organic GH deficiency due to a variety of causes such as congenital malformations and syndromes, genetic disorders or treatment for leukaemia or central nervous system tumours and short stature in children born small for gestational age, specific syndromes and systemic disorders. Each growth disorder is also covered by a review of relevant published data by international experts. KIGS has also established itself as a primary source of information about adverse events during long-term GH treatment in children. The recent analysis of KIGS data has revealed no new adverse drug reactions since the 10-year follow-up. Therefore, treatment with GH seems a low-risk intervention in children and adolescents with various growth disorders. The process of developing disease-specific growth response prediction models has been ongoing in KIGS for many years. The available models are accurate, precise and have a relatively high degree of predictive power, although further predictors of the growth response remain to be identified. The KIGS prediction models can be applied prospectively to new patients, enabling their GH therapy to be better tailored and monitored to achieve optimal growth, safety and cost outcomes. The future of KIGS within the era of evidence-based medicine will continue to depend upon the quality of the data reported. Therefore, the commitment of participating physicians will continue to be a decisive element. The ongoing recognition of the importance of valid safety and efficacy information in the practice of paediatric endocrinology is exemplified by this valuable international collaboration of clinicians and the pharmaceutical community.
It has been known for over 40 years that GH-deficient-children benefit from replacement with the hormone. But GH, essential for longitudinal growth, also plays a role after completion of final height. With the introduction of biosynthetic human GH 20 years ago, the use of GH was no longer restricted to severe growth retardation in hypopituitary children. This book will take the reader behind the myths of GH and into the real world of clinical endocrinology. The contributions stem from recognized clinicians and scientists who have been working in the field for decades. The contents encompass traditional end points of GH therapy such as body composition, bone biology and physical performance. Attention is also devoted to diagnostic aspects and side effects. Additional features range from clinical epidemiology to quality of life, and novel areas such as the impact of traumatic brain injury on pituitary function are also covered. The present volume of Frontiers of Hormone Research is essential reading for health care professionals interested in clinical endocrinology and GH.
A state-of-the-art and concise guide to the clinical management of pediatric endocrine disorders, the second edition of the highly regarded Pediatric Endocrinology: A Practical Clinical Guide covers the most common and challenging conditions seen by practicing endocrinologists and primary care physicians, including growth, hypothalamic, pituitary, adrenal, thyroid, calcium and bone, and reproductive disorders, as well as metabolic syndromes. This expanded second edition includes new topics being seen more commonly in pediatric endocrinology practices related to obesity and type 2 diabetes mellitus and lipid disorders. Each chapter contains an introductory discussion of the problem, a review of the clinical features that characterize it, the criteria needed to establish a diagnosis, and a comprehensive therapy section delineating the risks and benefits of the best therapeutic options available. Invaluable tables summarize the critical factors in etiology, clinical presentation, diagnosis, and therapeutic dosages. Pediatric Endocrinology: A Practical Clinical Guide, Second Edition, is a comprehensive resource for all clinicians concerned with the myriad endocrinologic disorders seen in children and adolescents.
Pediatric medical ethics are very different from any other clinical setting. This collection presents possible cases and scenarios to help caregivers be better-prepared for complicated ethical questions.
Gigantism and Acromegaly brings together pituitary experts, taking readers from bench research, to genetic analysis, clinical analysis, and new therapeutic approaches. This book serves as a reference for growth hormone over-secretion and its diagnosis and treatment for endocrinologists, pediatricians, internists, and neurosurgeons, and for geneticists. Pharmaceutical companies may use it as a reference for drug development and research. Students, residents and fellows in medicine and endocrinology and genetics will also find it valuable as it provides a single up-to-date review of the molecular biology of gigantism and acromegaly as well as recommended approaches to evaluation and management. Acromegaly is a rare pituitary disorder that slowly changes its adult victim's appearance over time: larger hands and feet, bigger jaw, forehead, nose, and lips. Generally, a benign pituitary tumor is the cause and symptoms of acromegaly can vary from patient to patient, making a diagnosis difficult and prolonging suffering for years. Early detection is key in the management of acromegaly as the pathologic effects of increased growth hormone (GH) production are progressive and can be life-threatening as the result of associated cardiovascular, cerebrovascular, and respiratory disorders and malignancies. - Accessible, up-to-date overview of the characteristics, state-of-the-art diagnostic procedures, and management of acromegaly and gigantism - Provides a unique compendium of endocrinology, genetics, clinical diagnosis and therapeutics - Contains contributions from internationally known experts who have treated patients with acromegaly and gigantism
A fascinating story of medical experimentation, parental love, and the extreme measures taken to make children fit within ?the norm.? Most people rarely think about their height beyond a little wishing and hoping. But for the parents of children who are ridiculed by their peers for being extraordinarily tall or extraordinarily short, height can cause great anguish. For decades, the medical establishment has responded to these worries by prescribing controversial treatments and therapies for children who fall outside of the ?normal? height range. While some have benefited, many have suffered from devastating side effects. In this riveting book, Susan Cohen and Christine Cosgrove provide a voice for the parents, doctors, scientists, and pharmaceutical companies involved in these experimental treatments. They also tell the story of the boys and girls themselves, many of them now grown, who were subjected to a wide range of non-FDA-approved medical procedures. These treatments? which consisted of extreme doses of estrogen, pituitary glands taken from both animals and human cadavers, and testosterone injections?often had disastrous side effects. Who is to say how tall is too tall, and how short is too short? For many of the individuals represented in this book, the answers have been clear?and they are grateful to the medical industry for improving upon nature. For others, left in the wake of this same science, the answers are fueled by tragic regret. The authors explore the dueling motives behind these procedures? with parents desperate to help their children ?fit in? and doctors and scientists hungry for scientific breakthroughs. Combining extensive research and in-depth interviews, Normal at Any Cost is the first book to place a human face on this complex and ethically charged medical history.
Everyone has heard of nature's "biological clocks", the phenomenon of periodic activity in plants, animals and humans. But what does chronobiology have to do with modern medicine? This book presents in a concise but comprehensive fashion the basic principles of chronobiology and their application to clinical medicine. The chapters are written by specialists in the field; they summarize the physiology, pathophysiology and pathology of the human time structure and outline the application of chronobiologic principles and techniques for diagnosis and treatment.
This book is a comprehensive and practical guide to assessing skeletal maturity and predicting adult height in children. It takes the reader through the main scoring systems and uses radiographs to illustrate the main stages of bone maturity in male and female children. The FREE CD-ROM contains a growth height prediction program, helping to predict growth height for each patient and storing data for comparison as the patient grows.