CRC - Growth Disorders

Organization: CRC
Publication Date: 29 June 2007
Page Count: 706

Preface to the second edition

Since the first edition of this book there have been many developments in the understanding of growth disorders at the molecular, cellular and biochemical levels, and in their management. This extensively revised second edition reflects these advances and also the better evidence base for our treatments where this has become available over the last nine years. It is a pleasure to welcome a number of new authors for this edition and those retained have extensively revised their contributions to reflect this progress and the developing evidence base.

Understanding normal and abnormal growth remains as fundamental to the clinical practice of paediatrics and paediatric endocrinology as ever, despite or even because of such advances in the basic science underpinning growth and its perturbations, and the development of new treatment modalities. Once again, our aim has been to produce a wide-ranging, stimulating and balanced account of the challenging field of growth and growth disorders. Even now, managing growth disorders in children remains both a science and an art - many tests in paediatric endocrinology (not least tests of growth hormone secretory ability) give the least useful information when there is most uncertainty from a clinical assessment and vice versa. We still fall into the trap of thinking that because we can measure something (or think we can) it must be an important and relevant measurement: what we can measure easily is not necessarily more important than what we cannot.

Height is not a validated proxy for quality of life. We are still poor at measuring quality of life in children with chronic disorders or short stature or, conversely, at measuring the emotional cost of coping in psychological terms. Whilst non-compliance is the commonest reason for therapeutic failure, we are beginning to explore the underlying genetic differences between individuals that may affect outcome (pharmacogenomics).

We recognise that well designed randomised controlled trials in large enough cohorts of patients (requiring national and international cooperative research) are necessary to distinguish absence of effect from no effect and need to show potentially clinically (rather than just statistically) significant benefit. However, significant side effects and harm are not generally identifiable in such studies. Large scale long term surveillance is necessary and should be the responsibility of all clinicians involved in (for example) GH therapy in children whether or not such patients are being formally followed up and treated in adulthood.

Instead of 'knowing all the answers' we are now (perhaps) beginning to ask (some of) the right questions and admitting that a 'right' answer today may not be the right answer next year, let alone in another nine years from now.

We hope that this new edition will again prove a practical help and guide for the clinician to the diverse physical and emotional disorders in children that are associated with disturbances of linear growth, and to their appropriate investigation and management.

We are grateful to our many contributors, to Professor Melvin Grumbach for writing the Foreword to this edition and to Joanna Koster, Sarah Burrows, Naomi Wilkinson and Francesca Naish of Hodder Arnold who have helped to see this second edition through to completion.