Orthopedics - Oleksa A.P. 2006

Metabolic bone diseases
Endocrine skeletal disorders
Pituitary dwarfism

If pituitary function is impaired, growth and bodily maturation slow down, resulting in dwarfism, while the overall appearance remains childlike (Fig. 86). Although pituitary dwarfism is quite rare, it can be difficult to differentiate from dwarfism of other origins, particularly in childhood. During Puberty, the cause of dwarfism is easier to identify because patients with pituitary hypofunction fail to undergo sexual maturation, which distinguishes them from individuals with constitutionally delayed growth.

Pituitary dwarfism can be distinguished from hypothyroidism-related dwarfism by preserved intellect, as children with thyroid hypofunction suffer from mental retardation.

Furthermore, short stature due to gonadal aplasia is differentiated from pituitary dwarfism by measuring urinary gonadotropin levels. In gonadal aplasia, urinary gonadotropin excretion is elevated due to increased stimulation by the hypothalamo-pituitary system, whereas in pituitary dwarfism, gonadotropin is absent or deficient in the urine.

X-ray findings in pituitary dwarfism reveal smaller, underdeveloped bones with delayed maturation and persistent epiphyseal growth plates even in adulthood. Additionally, growth plates in small bones remain unclosed (without calcification) for a prolonged period, accompanied by delayed Ossification of the bone nuclei.

Class="center">

Fig. 86. Pituitary dwarf (patient age 30 years, height 126 cm).

Treatment. Attempts to treat pituitary dwarfism have not yielded satisfactory results. Anterior pituitary extracts have shown no therapeutic effect, although positive outcomes have been reported with human Growth Hormone (Guillemin) and gonadotropin (Goldman, Thom, Cahill). Children with pituitary dwarfism have a shortened Life expectancy and typically succumb to intercurrent infections or accidental diseases.