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This study examines the sex difference in the rate of referral to a
pediatric endocrinology center for evaluation of short stature or
poor growth. The source of data was medical charts from all patients
initially evaluated during 2001. After exclusion of those with a
prior evaluation by a pediatric endocrinologist for treatment with
growth hormone (GH) (n= 4), referral for evaluation of pituitary
function secondary to brain disease or abnormality (n=15), and girls
with known Turner syndrome (n=6), the medical records of 278 patients
were available for analysis. The
table indicates multiple statistically significant disparities in
anthropometric characteristics of boys and girls at the time of the
initial visit to the pediatric endocrinologist.
Grimberg A, Kutikov JK, Cucchiara AJ. Sex differences in patients referred for
evalution of poor growth. J Pediatr.
2005;146:212-216.
Editor’s
Comment: This is not the first epidemiologically-oriented study
that has detected a sex difference in referral patterns.1
Similarly, a survey demonstrated that pediatric endocrinologists were
more likely to recommend GH therapy for boys with idiopathic short
stature than for a girls with identical auxologic characteristics.2
Converging evidence from these and additional studies replicate
the societal bias that taller stature is more important in boys/men
than in girls/women.3 The fact that this bias is reflected
in pediatric care is worrisome however. The under-representation of
girls receiving growth evaluations raises the possibility of missed
or late diagnoses. Alternatively, the over-representation of short
boys in pediatric endocrinology referrals raises the possibility that
health care has become complicit in societal prejudices along with
the added burden to the patient of potential medical and
psychological risks (recognized and unknown) as well as economic
costs. This study raises an additional cause for concern: the majority of
patients (59%) referred to one pediatric endocrinology clinic for a
growth evaluation, arrived without plotted growth measurements. Other
studies have shown that inaccurate height measurement tools are often
used in primary care.4 What is needed is a return to
fundamental practice, recommended by the American Academy of
Pediatrics5 of routine growth monitoring in primary care
to differentiate healthy from pathological growth. Evidence of a
strong sex bias in referral to a specialist suggests that clinicians
(and parents) are possibly over-valuing “height” and
possibly devaluing “growth” to the detriment of girls, in
particular, and society at large.
David E. Sandberg, PhD
Reference - (linked to  )
- Lindsay
R, Feldkamp M, Harris D, Robertson J, Rallison M. J Pediatr. 1994;125:29-35.
- Cuttler JAMA. 1996; 276:531-537.
- Sandberg DE, Colsman M, Voss LD. Short stature and quality of life: A review
of assumptions and evidence. In: Pescovitz OH, Eugster E, eds. Pediatric Endocrinology: Mechanisms, Manifestations, and
Management. Philadelphia, PA: Lippincot, Williams & Wilkins;
2004:191-202.
- Lipman
TH, Hench K, Logan JD, DiFazio DA, Hale PM, Singer-Granick C. J
Pediatr Health Care. 2000;14:166-171.
- AAP.
Committee on Practice and Ambulatory Medicine. Pediatrics. 2000;105:645-646.
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Current GGH - Vol. 24 No. 1
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