Dr. A A Mafqood

The term short stature describes the height of the person that is significantly below the average height for a person's age, sex, racial group, or family. Growth failure is often confused with short stature. Growth failure that occurs over time eventually results in short stature. By definition, growth failure is a medical condition. However, short stature is often a normal variant.

Short stature may or may not be a sign or symptom caused by a medical condition. Your child's growth must be assessed over a period of time and not just at a single point.  Any departure from a prior growth pattern, appropriate for the child's genetic background may signal the appearance of a disease.

Symptoms

Short parents tend to have short children. Children with a family backgroud of short stature does not have any symptoms related to diseases that affect growth.  Children with constitutional growth delay do not have any diseases. These children enter puberty later than their peers. However, because they continue to grow for a longer period of time, they catch up to their peers as they reach their adult height, which is normal and comparable to their parents.

Some symptoms may signal a medical condition causing short stature. The following symptoms should be further investigated by your doctor:

1. Child has stopped growing or is growing slower than expected (less than 4 cm, or 2 in, each year in the pre-pubertal child of elementary school age)
2. Weight loss or gain (more than 5 lbs in a month)
3. Poor nutrition/loss of appetite
4. Delayed puberty (absent breast development by age 14 or absent menstrual spotting by age 15 for a girl or absent enlargement of the testes by age 14 for a boy); note that the presence or absence of pubic hair is not a reliable sign of pubertal development

What Causes Short Stature?

The three major reasons for short stature are constitutional growth delay, genetics and disease.

Constitutional Growth Delay: Some children simply develop later than others. These children are often referred to as 'late bloomers'. These kids are small for their age and often enter puberty later. However, they'll continue to grow after their friends have stopped. They usually catch up by adulthood.

Genetics: If one or both parents are short, there's a strong possibility that their child will also be short. If there are no underlying medical reasons why either parent is short, their child's short stature may be perfectly healthy.

Disease: A number of diseases may cause unusually short stature. These diseases fall into several categories:

1. Endocrine diseases affect hormone production and often height. These include growth hormone deficiency (GHD), hypothyroidism, or low thyroid hormone levels, and Cushing's disease.
2. Chronic diseases can also decrease height through their effects on overall health. Examples of chronic disease are heart disease, asthma, inflammatory bowel disease, diabetes, kidney problems, sickle cell anemia, and juvenile rheumatoid arthritis.
3. Genetic conditions that affect height include Down syndrome, Turner syndrome, and Williams syndrome.
4. Bone and skeletal diseases, such as rickets or achondroplasia, may change stature through their effects on bone growth.

Problems during pregnancy can affect the height of a child. Malnutrition can also lead to short stature.

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Research has shown that users of Viagra sildenafil are at a higher risk for developing melanoma. There are reports stating that about 45 million men are at an increased risk of developing melanoma due to associated Viagra sildenafil use. The risk of developing melanoma was found to increase in men using ED drugs by 21%. Though there is no conclusive proof as yet that sildenafil is the cause, research is increasingly pointing out its role in melanoma. For example, PDE5 inhibitors (sildenafil, tadalafil, vardenafil) are known to promote melanin synthesis, which may exacerbate melanoma development.

The analysis of biochemical pathways of this correlation suggests that Viagra sildenafil triggers a special biochemical action involving the growth-stimulating cGMP (cyclic guanosine monophosphate (an intracellular signaling molecule) which in turn promotes the growth of malignant melanoma. In normal cases, the enzyme phosphodiesterase type 5 (PDE5) regulates the cGMP preventing any adverse cellular activity. Sildenafil inhibits the production of this enzyme, and potentiates a specific cGMP-related biochemical mechanism (called cGMP-cGKI pathway) , and thereby contributes to malignant melanoma. This has been proven to happen in mice and is yet to be proven in humans.

However, there are also reports which suggest that this does not happen due to Viagra sildenafil per se, but due to greater exposure to sun, which even otherwise increases the chances of skin cancer in general, and melanoma in particular. The countering theories also say that the population in which skin cancer was detected, comprised mostly of high income individuals who spent a significant amount of time holidaying on beaches and are not connected to the extensive use of Viagra per se. 

Therefore, though there is a correlation that has been established, there is no definite proof that Viagra sildenafil causes skin cancer. It is however, advisable to use ED drugs after medical consultation. If a patient has a genetic predisposition to develop melanoma, it is advisable to seek medical advice before the use of ED drugs. Occasional use should not be harmful. Also, when going out in the sun, limiting exposure to direct sun and UV protection should be managed too.