Autor(s): R.M. Dorizzi
The article shortly summarizes the deep clinical roots of Endocrinology and particularly of Pediatric Endocrinology. The principal clinical context of short stature and its effects on health policy are discussed. The investigation of short stature is still based on stimulation tests but they are nor physiological nor consistent not only in different laboratories but also in the same laboratory. The accurate measurement of growth hormone and IGF-I is hampered by lack of standardization of reagents and calibrators. Furthermore, the diagnosis of precocious puberty, delayed puberty and polycystic ovary syndrome is discussed; even if it is very important (these conditions, deeply affecting the quality of life of child, adolescent and adult) it is not very effectively supported by the clinical laboratory. Until now, the several manufacturers of in-vitro devices operating in the field did not show interest in participating or promoting national, or multi-center, programs for improving standardization of tests and analyzers. A major problem is the lack of proper pediatric reference intervals also concerning common tests such as thyroid function assays. An assessment of the recent literature on the subject demonstrated: 1) the few data stored in the major databases (e.g. PubMed and Embase); 2) most of the data have been obtained using methods and analyzers no more marketed or available; 3) the results have been very often obtained using population of different countries, continents and races.