Table of Contents 21-2

Sex Differences in Patients Referred for Evaluation of Poor Growth

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 )

1. Lindsay R, Feldkamp M, Harris D, Robertson J, Rallison M. J Pediatr. 1994;125:29-35.
2. Cuttler JAMA. 1996; 276:531-537.
3. 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.
4. Lipman TH, Hench K, Logan JD, DiFazio DA, Hale PM, Singer-Granick C. J Pediatr Health Care. 2000;14:166-171.
5. AAP. Committee on Practice and Ambulatory Medicine. Pediatrics. 2000;105:645-646.