Dwarfism

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This article is about the medical condition. Dwarfism_sentence_0

For the legendary creature, see Dwarf (mythology). Dwarfism_sentence_1

For other uses, see Dwarf. Dwarfism_sentence_2

Dwarfism_table_infobox_0

DwarfismDwarfism_header_cell_0_0_0
PronunciationDwarfism_header_cell_0_1_0 Dwarfism_cell_0_1_1
SpecialtyDwarfism_header_cell_0_2_0 Endocrinology, medical geneticsDwarfism_cell_0_2_1
CausesDwarfism_header_cell_0_3_0 Hyposecretion of growth hormone from pituitary gland (growth hormone deficiency), genetic disordersDwarfism_cell_0_3_1

Dwarfism occurs when an organism is extremely small. Dwarfism_sentence_3

In humans, it is sometimes defined as an adult height of less than 147 centimetres (4 ft 10 in), regardless of sex; the average adult height among people with dwarfism is 122 centimetres (4 ft 0 in), although some individuals with dwarfism are slightly taller. Dwarfism_sentence_4

Disproportionate dwarfism is characterized by either short limbs or a short torso. Dwarfism_sentence_5

In cases of proportionate dwarfism, both the limbs and torso are unusually small. Dwarfism_sentence_6

Intelligence is usually normal, and most have a nearly normal life expectancy. Dwarfism_sentence_7

The most common and recognisable form of dwarfism in humans is the genetic disorder achondroplasia, comprising 70% of cases. Dwarfism_sentence_8

Growth hormone deficiency is responsible for most other cases. Dwarfism_sentence_9

Treatment depends on the underlying cause. Dwarfism_sentence_10

Those with genetic disorders can sometimes be treated with surgery or physical therapy. Dwarfism_sentence_11

Hormone disorders can also be treated with growth hormone therapy before the child's growth plates fuse. Dwarfism_sentence_12

Individual accommodations, such as specialized furniture, are often used by people with dwarfism. Dwarfism_sentence_13

Many support groups provide services to aid individuals and the discrimination they may face. Dwarfism_sentence_14

In addition to the medical aspect of the condition, there are also social aspects. Dwarfism_sentence_15

For a person with dwarfism, height discrimination can lead to ridicule in childhood and discrimination in adulthood. Dwarfism_sentence_16

In the United Kingdom, United States, Canada, Australia, and other English-speaking countries, labels that some people with dwarfism accept include dwarf, little person (LP), or person of short stature. Dwarfism_sentence_17

Historically, the term "midget" was used to describe proportionate dwarfs; however, this term is now regarded as offensive by some. Dwarfism_sentence_18

Signs and symptoms Dwarfism_section_0

A defining characteristic of dwarfism is an adult height less than the 2.3rd percentile of the CDC standard growth charts. Dwarfism_sentence_19

There is a wide range of physical characteristics. Dwarfism_sentence_20

Variations in individuals are identified by diagnosing and monitoring the underlying disorders. Dwarfism_sentence_21

There may not be any complications outside adapting to their size. Dwarfism_sentence_22

Short stature is a common replacement of the term 'dwarfism', especially in a medical context. Dwarfism_sentence_23

Short stature is clinically defined as a height within the lowest 2.3% of those in the general population. Dwarfism_sentence_24

However, those with mild skeletal dysplasias may not be affected by dwarfism. Dwarfism_sentence_25

In some cases of untreated hypochondroplasia, males grow up to 5 feet 5 inches. Dwarfism_sentence_26

Though that is short in a relative context, it does not fall into the extreme ranges of the growth charts. Dwarfism_sentence_27

Disproportionate dwarfism is characterized by shortened limbs or a shortened torso. Dwarfism_sentence_28

In achondroplasia one has an average-sized trunk with short limbs and a larger forehead. Dwarfism_sentence_29

Facial features are often affected and individual body parts may have problems associated with them. Dwarfism_sentence_30

Spinal stenosis, ear infection, and hydrocephalus are common. Dwarfism_sentence_31

In case of spinal dysostosis, one has a small trunk, with average-sized limbs. Dwarfism_sentence_32

Proportionate dwarfism is marked by a short torso with short limbs, thus leading to a height that is significantly below average. Dwarfism_sentence_33

There may be long periods without any significant growth. Dwarfism_sentence_34

Sexual development is often delayed or impaired into adulthood. Dwarfism_sentence_35

This dwarfism type is caused by an endocrine disorder and not a skeletal dysplasia. Dwarfism_sentence_36

Physical effects of malformed bones vary according to the specific disease. Dwarfism_sentence_37

Many involve joint pain caused by abnormal bone alignment, or from nerve compression. Dwarfism_sentence_38

Early degenerative joint disease, exaggerated lordosis or scoliosis, and constriction of spinal cord or nerve roots can cause pain and disability. Dwarfism_sentence_39

Reduced thoracic size can restrict lung growth and reduce pulmonary function. Dwarfism_sentence_40

Some forms of dwarfism are associated with disordered function of other organs, such as the brain or liver, sometimes severely enough to be more of an impairment than the unusual bone growth. Dwarfism_sentence_41

Mental effects also vary according to the specific underlying syndrome. Dwarfism_sentence_42

In most cases of skeletal dysplasia, such as achondroplasia, mental function is not impaired. Dwarfism_sentence_43

However, there are syndromes which can affect the cranial structure and growth of the brain, severely impairing mental capacity. Dwarfism_sentence_44

Unless the brain is directly affected by the underlying disorder, there is little to no chance of mental impairment that can be attributed to dwarfism. Dwarfism_sentence_45

The psycho-social limitations of society may be more disabling than the physical symptoms, especially in childhood and adolescence, but people with dwarfism vary greatly in the degree to which social participation and emotional health are affected. Dwarfism_sentence_46

Dwarfism_unordered_list_0

  • Social prejudice against extreme shortness may reduce social and marital opportunities.Dwarfism_item_0_0
  • Numerous studies have demonstrated reduced employment opportunities. Severe shortness is associated with lower income.Dwarfism_item_0_1
  • Self-esteem may suffer and family relationships may be affected.Dwarfism_item_0_2
  • Extreme shortness (in the low 2- to 3-foot [60–90 cm] range) can, if not accommodated for, interfere with activities of daily living, like driving or using countertops built for taller people. Other common attributes of dwarfism such as bowed knees and unusually short fingers can lead to back problems and difficulty in walking and handling objects.Dwarfism_item_0_3
  • Children with dwarfism are particularly vulnerable to teasing and ridicule from classmates. Because dwarfism is relatively uncommon, children may feel isolated from their peers.Dwarfism_item_0_4

Causes Dwarfism_section_1

Dwarfism can result from many medical conditions, each with its own separate symptoms and causes. Dwarfism_sentence_47

Extreme shortness in humans with proportional body parts usually has a hormonal cause, such as growth-hormone deficiency, once called pituitary dwarfism. Dwarfism_sentence_48

Two disorders, achondroplasia and growth hormone deficiency, are responsible for the majority of human dwarfism cases. Dwarfism_sentence_49

Achondroplasia Dwarfism_section_2

Further information: Achondroplasia Dwarfism_sentence_50

The most recognizable and most common form of dwarfism in humans is achondroplasia, which accounts for 70% of dwarfism cases, and occurs in 4 to 15 out of 100,000 live births. Dwarfism_sentence_51

It produces rhizomelic short limbs, increased spinal curvature, and distortion of skull growth. Dwarfism_sentence_52

In achondroplasia the body's limbs are proportionately shorter than the trunk (abdominal area), with a larger head than average and characteristic facial features. Dwarfism_sentence_53

Achondroplasia is an autosomal dominant disorder caused by the presence of a faulty allele in the genome. Dwarfism_sentence_54

If a pair of achondroplasia alleles are present, the result is fatal. Dwarfism_sentence_55

Achondroplasia is a mutation in the fibroblast growth factor receptor 3. Dwarfism_sentence_56

In the context of achondroplasia, this mutation causes FGFR3 to become constitutively active, inhibiting bone growth. Dwarfism_sentence_57

Growth hormone deficiency Dwarfism_section_3

Further information: Growth hormone deficiency Dwarfism_sentence_58

Growth hormone deficiency (GHD) is a medical condition in which the body produces insufficient growth hormone. Dwarfism_sentence_59

Growth hormone, also called somatotropin, is a polypeptide hormone which stimulates growth and cell reproduction. Dwarfism_sentence_60

If this hormone is lacking, stunted or even halted growth may become apparent. Dwarfism_sentence_61

Children with this disorder may grow slowly and puberty may be delayed by several years or indefinitely. Dwarfism_sentence_62

Growth hormone deficiency has no single definite cause. Dwarfism_sentence_63

It can be caused by mutations of specific genes, damage to the pituitary gland, Turner's syndrome, poor nutrition, or even stress (leading to psychogenic dwarfism). Dwarfism_sentence_64

Laron syndrome (growth hormone insensitivity) is another cause. Dwarfism_sentence_65

Those with growth hormone issues tend to be proportionate. Dwarfism_sentence_66

Other Dwarfism_section_4

Other causes of dwarfism are spondyloepiphyseal dysplasia congenita, diastrophic dysplasia, pseudoachondroplasia, hypochondroplasia, Noonan syndrome, primordial dwarfism, Turner syndrome, osteogenesis imperfecta (OI), and hypothyroidism. Dwarfism_sentence_67

Severe shortness with skeletal distortion also occurs in several of the Mucopolysaccharidoses and other storage disorders. Dwarfism_sentence_68

Hypogonadotropic hypogonadism may cause proportionate, yet temporary, dwarfism. Dwarfism_sentence_69

Serious chronic illnesses may produce dwarfism as a side effect. Dwarfism_sentence_70

Harsh environmental conditions, such as malnutrition, may also produce dwarfism. Dwarfism_sentence_71

These types of dwarfism are indirect consequences of the generally unhealthy or malnourished condition of the individual, and not of any specific disease. Dwarfism_sentence_72

The dwarfism often takes the form of simple short stature, without any deformities, thus leading to proportionate dwarfism. Dwarfism_sentence_73

In societies where poor nutrition is widespread, the average height of the population may be reduced below its genetic potential by the lack of proper nutrition. Dwarfism_sentence_74

Sometimes there is no definitive cause of short stature. Dwarfism_sentence_75

Diagnosis Dwarfism_section_5

Dwarfism is often diagnosed in childhood on the basis of visible symptoms. Dwarfism_sentence_76

A physical examination can usually suffice to diagnose certain types of dwarfism, but genetic testing and diagnostic imaging may be used to determine the exact condition. Dwarfism_sentence_77

In a person's youth, growth charts that track height can be used to diagnose subtle forms of dwarfism that have no other striking physical characteristics. Dwarfism_sentence_78

Short stature or stunted growth during youth is usually what brings the condition to medical attention. Dwarfism_sentence_79

Skeletal dysplasia is usually suspected because of obvious physical features (e.g., unusual configuration of face or shape of skull), because of an obviously affected parent, or because body measurements (arm span, upper to lower segment ratio) indicate disproportion. Dwarfism_sentence_80

Bone X-rays are often key to diagnosing a specific skeletal dysplasia, but are not the sole diagnostic tool. Dwarfism_sentence_81

Most children with suspected skeletal dysplasias are referred to a genetics clinic for diagnostic confirmation and genetic counseling. Dwarfism_sentence_82

Since about the year 2000, genetic tests for some of the specific disorders have become available. Dwarfism_sentence_83

During an initial medical evaluation of shortness, the absence of disproportion and other clues listed above usually indicates causes other than bone dysplasias. Dwarfism_sentence_84

Classification Dwarfism_section_6

In men and women, the sole requirement for being considered a dwarf is having an adult height under 147 cm (4 ft 10 in) and it is almost always classified with respect to the underlying condition that is the cause of the short stature. Dwarfism_sentence_85

Dwarfism is usually caused by a genetic variant; achondroplasia is caused by a mutation on chromosome 4. Dwarfism_sentence_86

If dwarfism is caused by a medical disorder, the person is referred to by the underlying diagnosed disorder. Dwarfism_sentence_87

Disorders causing dwarfism are often classified by proportionality. Dwarfism_sentence_88

Disproportionate dwarfism describes disorders that cause unusual proportions of the body parts, while proportionate dwarfism results in a generally uniform stunting of the body. Dwarfism_sentence_89

Disorders that cause dwarfism may be classified according to one of hundreds of names, which are usually permutations of the following roots: Dwarfism_sentence_90

Dwarfism_unordered_list_1

  • locationDwarfism_item_1_5
    • rhizomelic = root, i.e., bones of the upper arm or thighDwarfism_item_1_6
    • mesomelic = middle, i.e., bones of the forearm or lower legDwarfism_item_1_7
    • acromelic = end, i.e., bones of hands and feet.Dwarfism_item_1_8
    • micromelic = entire limbs are shortenedDwarfism_item_1_9
  • sourceDwarfism_item_1_10
    • chondro = of cartilageDwarfism_item_1_11
    • osteo = of boneDwarfism_item_1_12
    • spondylo = of the vertebraeDwarfism_item_1_13
    • plasia = formDwarfism_item_1_14
    • trophy = growthDwarfism_item_1_15

Examples include achondroplasia and chondrodystrophy. Dwarfism_sentence_91

Prevention Dwarfism_section_7

Many types of dwarfism are currently impossible to prevent because they are genetically caused. Dwarfism_sentence_92

Genetic conditions that cause dwarfism may be identified with genetic testing, by screening for the specific variations that result in the condition. Dwarfism_sentence_93

However, due to the number of causes of dwarfism, it may be impossible to determine definitively if a child will be born with dwarfism. Dwarfism_sentence_94

Dwarfism resulting from malnutrition or a hormonal abnormality may be treated with an appropriate diet or hormonal therapy. Dwarfism_sentence_95

Growth hormone deficiency may be remedied via injections of human growth hormone (HGH) during early life. Dwarfism_sentence_96

Management Dwarfism_section_8

Genetic mutations of most forms of dwarfism caused by bone dysplasia cannot be altered yet, so therapeutic interventions are typically aimed at preventing or reducing pain or physical disability, increasing adult height, or mitigating psychosocial stresses and enhancing social adaptation. Dwarfism_sentence_97

Forms of dwarfism associated with the endocrine system may be treated using hormonal therapy. Dwarfism_sentence_98

If the cause is prepubescent hyposecretion of growth hormone, supplemental growth hormone may correct the abnormality. Dwarfism_sentence_99

If the receptor for growth hormone is itself affected, the condition may prove harder to treat. Dwarfism_sentence_100

Hypothyroidism is another possible cause of dwarfism that can be treated through hormonal therapy. Dwarfism_sentence_101

Injections of thyroid hormone can mitigate the effects of the condition, but lack of proportion may be permanent. Dwarfism_sentence_102

Pain and disability may be ameliorated by physical therapy, braces or other orthotic devices, or by surgical procedures. Dwarfism_sentence_103

The only simple interventions that increase perceived adult height are dress enhancements, such as shoe lifts or hairstyle. Dwarfism_sentence_104

Growth hormone is rarely used for shortness caused by bone dysplasias, since the height benefit is typically small (less than 5 cm [2 in]) and the cost high. Dwarfism_sentence_105

The most effective means of increasing adult height by several inches is distraction osteogenesis, though availability is limited and the cost is high in terms of money, discomfort, and disruption of life. Dwarfism_sentence_106

Most people with dwarfism do not choose this option, and it remains controversial. Dwarfism_sentence_107

For other types of dwarfism, surgical treatment is not possible. Dwarfism_sentence_108

Society and culture Dwarfism_section_9

Terminology Dwarfism_section_10

The appropriate term for describing a person of particularly short stature (or with the genetic condition achondroplasia) has historically been ambiguous, and has developed euphemistically over the past few centuries. Dwarfism_sentence_109

The noun dwarf stems from Old English dweorg, originally referring to a being from Germanic mythology—a dwarf—that dwells in mountains and in the earth, and is associated with wisdom, smithing, mining, and crafting. Dwarfism_sentence_110

The etymology of the word dwarf is contested, and scholars have proposed varying theories about the origins of the being, including that dwarfs may have originated as nature spirits or as beings associated with death, or as a mixture of concepts. Dwarfism_sentence_111

Competing etymologies include a basis in the Indo-European root *dheur- (meaning 'damage'), the Indo-European root *dhreugh (whence modern German Traum 'dream' and Trug 'deception'), and comparisons have been made with the Old Indian dhvaras (a type of demonic being). Dwarfism_sentence_112

The being may not have gained associations with small stature until a later period. Dwarfism_sentence_113

The terms "dwarf", "little person", "LP", and "person of short stature" are now generally considered acceptable by most people affected by these disorders. Dwarfism_sentence_114

However, the plural "dwarfs" as opposed to "dwarves" is generally preferred in the medical context, possibly because the plural "dwarves" was popularized by author J. Dwarfism_sentence_115 R. R. Tolkien, describing a race of characters in his The Lord of the Rings books resembling Norse dwarfs. Dwarfism_sentence_116

"Midget", whose etymology indicates a "tiny biting insect", came into prominence in the mid-19th century after Harriet Beecher Stowe used it in her novels Sunny Memories of Foreign Lands and Oldtown Folks where she described children and an extremely short man, respectively. Dwarfism_sentence_117

Later some people of short stature considered the word to be offensive because it was the descriptive term applied to P. Dwarfism_sentence_118 T. Barnum's dwarfs used for public amusement during the freak show era. Dwarfism_sentence_119

It is also not considered accurate as it is not a medical term or diagnosis, though it is sometimes used as a slang term to describe those who are particularly short, whether or not they have dwarfism. Dwarfism_sentence_120

Dwarf sports Dwarfism_section_11

Dwarfs are supported to compete in sport by a number of organisations nationally and internationally. Dwarfism_sentence_121

The Dwarf Athletic Association of America and the Dwarf Sports Association UK provide opportunities for dwarfs to compete nationally and internationally in the Americas and Europe, respectively. Dwarfism_sentence_122

The Dwarf Sports Association UK organises between 5 and 20 events per month for athletes with restricted growth conditions in the UK. Dwarfism_sentence_123

For instance, swimming and bicycling are often recommended for people with skeletal dysplasias, since those activities put minimal pressure on the spine. Dwarfism_sentence_124

Since its early days, professional wrestling has had the involvement of dwarf athletes. Dwarfism_sentence_125

"Midget wrestling" had its heyday in the 1950s–'70s, when wrestlers such as Little Beaver, Lord Littlebrook, and Fuzzy Cupid toured North America, and Sky Low Low was the first holder of the National Wrestling Alliance's World Midget Championship. Dwarfism_sentence_126

In the following couple of decades, more wrestlers became prominent in North America, including foreign wrestlers like Japan's Little Tokyo. Dwarfism_sentence_127

Although the term is seen by some as pejorative, many past and current midget wrestlers, including Hornswoggle, have said they take pride in the term due to its history in the industry and its marketability. Dwarfism_sentence_128

Art and media depictions Dwarfism_section_12

See also: List of Dwarfism media depictions, List of people with dwarfism, and Dwarfs and pygmies in Ancient Egypt Dwarfism_sentence_129

In art, literature, and movies, dwarfs are rarely depicted as ordinary people who are very short but rather as a species apart. Dwarfism_sentence_130

Novelists, artists, and moviemakers may attach special moral or aesthetic significance to their "apartness" or misshapenness. Dwarfism_sentence_131

Artistic representations of dwarfism can be found on Greek vases and other ancient artifacts, including ancient Egyptian art in which dwarfs are likely to have been seen as a divine manifestation, with records indicating they could reach high positions in society. Dwarfism_sentence_132

The Bhagavat Purana Hindu text devotes nine chapters to the adventures of Vamana, a dwarf avatar of Lord Vishnu. Dwarfism_sentence_133

Depictions of dwarfism are also found in European paintings and many illustrations. Dwarfism_sentence_134

Many European paintings (especially Spanish) of the 16th–19th centuries depict dwarfs by themselves or with others. Dwarfism_sentence_135

In the Talmud, it is said that the second born son of the Egyptian Pharaoh of the Bible was a dwarf. Dwarfism_sentence_136

Recent scholarship has suggested that ancient Egyptians held dwarfs in high esteem. Dwarfism_sentence_137

Several important mythological figures of the North American Wyandot nation are portrayed as dwarfs. Dwarfism_sentence_138

As popular media have become more widespread, the number of works depicting dwarfs have increased dramatically. Dwarfism_sentence_139

Dwarfism is depicted in many books, films, and TV series such as Willow, The Wild Wild West, The Man with the Golden Gun (and later parodied in Austin Powers), Gulliver's Travels by Jonathan Swift, The Wizard of Oz, Willy Wonka & the Chocolate Factory, Bad Santa, A Son of the Circus, Little People, Big World, The Little Couple, A Song of Ice and Fire (and its TV adaptation Game of Thrones), Seinfeld, The Orator, In Bruges, The Tin Drum by Günter Grass, the short-lived reality show The Littlest Groom, and the films The Station Agent and Zero. Dwarfism_sentence_140

The Animal Planet TV series Pit Boss features dwarf actor Shorty Rossi and his talent agency, "Shortywood Productions", which Rossi uses to provide funding for his pit bull rescue operation, "Shorty's Rescue". Dwarfism_sentence_141

Rossi's three full-time employees, featured in the series, are all little people and aspiring actors. Dwarfism_sentence_142

In September 2014, Creative Business House, along with Donnons Leur Une Chance, created the International Dwarf Fashion Show to raise awareness and boost self-confidence of people living with dwarfism. Dwarfism_sentence_143

See also Dwarfism_section_13

Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Dwarfism.