Sex and growth

Article Outline

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Disturbances of growth constitute one of the major reasons for referral from primary care practices to pediatric endocrinologists. It is frequently observed that males are more commonly referred for growth failure than females. What is not clear, however, is whether this reflects some underlying biologic reality or whether there could be some biases inherent in such referrals. A thought-provoking examination of this question is published in this issue of The Journal.

A few years ago, Grimberg et al in Philadelphia published a study in The Journal showing a 2:1 preponderence of boys being referred to a specialty growth center, and demonstrated that many of them had height deficits which were less dramatic than those of referred girls (J Pediatr 2005;146:212-6). The same group examined this issue further by studying growth faltering in a huge population of children being followed in primary care clinics which were part of the referral network for their growth center. Using a strict definition of growth faltering, the investigators looked at a number of potential associations. In this study, male sex was not more common in children with growth faltering, in spite of its overrepresentation in referrals and, in other studies, with the use of rhuGH therapy. Clearly, there are some non-biologic factors implicit in referral for evaluation of growth.