Vasques Gabriela A, Andrade Nathalia L M, Jorge Alexander A L
Unidade de Endocrinologia Genética (LIM25), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM42), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
Arch Endocrinol Metab. 2019 Feb;63(1):70-78. doi: 10.20945/2359-3997000000105.
Short stature is a common feature, and frequently remains without a specific diagnosis after conventional clinical and laboratorial evaluation. Longitudinal growth is mainly determined by genetic factors, and hundreds of common variants have been associated to height variability among healthy individuals. Although isolated short stature may be caused by the combination of variants, with a deleterious impact on the growth of individuals with polygenic inheritance, recent studies have pointed out some monogenic defects as the cause of the growth disorder observed in nonsyndromic children. The majority of these defects are in genes related to the growth plate cartilage and in the growth hormone (GH) - insulin-like growth factor 1 (IGF-1) axis. Affected patients usually present the mildest spectrum of some forms of skeletal dysplasia, or subtle abnormalities of laboratory tests, suggesting hormonal resistance or insensibility. The lack of specific characteristics, however, does not allow formulation of a definitive diagnosis without the use of broad genetic studies. Thus, molecular genetic studies including panels of genes or exome analysis will become essential in investigating and identifying the causes of isolated short stature in children, with a crucial impact on treatment and follow-up.
身材矮小是一种常见特征,在经过传统的临床和实验室评估后,通常仍无法做出明确诊断。纵向生长主要由遗传因素决定,数百种常见变异与健康个体的身高差异有关。虽然孤立性身材矮小可能是由多种变异组合引起的,对多基因遗传个体的生长产生有害影响,但最近的研究指出,一些单基因缺陷是导致非综合征儿童生长障碍的原因。这些缺陷大多存在于与生长板软骨和生长激素(GH)-胰岛素样生长因子1(IGF-1)轴相关的基因中。受影响的患者通常表现出某些形式的骨骼发育不良的最轻微症状,或实验室检查的细微异常,提示激素抵抗或不敏感。然而,由于缺乏特异性特征,如果不进行广泛的基因研究,就无法做出明确诊断。因此,包括基因 panel 或外显子组分析在内的分子遗传学研究对于调查和确定儿童孤立性身材矮小的原因至关重要,对治疗和随访具有关键影响。