The primary objective of this study has been to determine timr
prevalence of growth hormone deficiency among Scottish school children. To achieve this it m first essential to identify a large
number of very small children in a defined population and it was
proposed to study thereafter all those comprising the smallest 1% in
the population.
Clearly, sany children had factors other than growth horsona
deficiency contributing to their short stature, and therefore the
literature relating both to this and the influences of genetic,
environmental and other biological factors upon growth has been
reviewed.
The method originally proposed for identifying these children
was based upon a central computer-baaed file of the heights of
children at the school entrance medical inspection. Intractable
difficulties inherent in this approach soon emerged and, as these
would have prevented the identification of all short children within
a defined population and made it impossible to accurately estimate
the true prevalence of growth hormone deficiency, this method had to
be discarded.
The revised method entailed personally screening the heights of
48,221 children attending all education authority schools and &
selection of independent schools in Edinburgh, Glasgow and Aberdeen,
and identifying from them all children who were -2.5 standard
deviations or more below the mm height for their chronological age
(N = 449).
Permission was sought from the parents of those found to be of
small stature to undertake studies of the medical and social background
and where appropriate to gather auxological data. Where no
definite cause for short stature was apparent, these children were
screened for growth horaone deficiency wherever possible. Children
who failed to produce adequate growth hormone levels on the
screening test and/or those whose twelve aonth height velocities
were below average (less than the 25th centile for chronological
age) were then further investigated for growth hormone deficiency
with an insulin tolerance test.
A group of control children from a similar social background
but of average height for age was also selected in .Edinburgh and
Glasgow. c.oae of the social and medical data from this group has
been compared to the group of children with short stature in an
attempt to identify any significant differences, the study has
confirmed the strong association of previously recognised environmental
and genetic factors with short stature.
The results of the study also suggest that severe growth
horaone deficiency is a acre comma cause of short stature than
previously thought and that it frequently remains undiagnosed for
longer than necessary