Dwarfism

Dwarfism Classification and external resources
Warwick Davis, an English actor with dwarfism.
ICD-10	E23.0, E34.2, E45.0, Q77.4
ICD-9	253.3, 259.4
DiseasesDB	80
MedlinePlus	001176

Dwarfism (dwo[ʀ]fiz'm IPA: /ˈdwɔəɹˌfɪzəm/) is a medical condition in humans characterized by extreme small size.^[1] The most widely accepted definition of a dwarf is a person with an adult height of less than 4 feet 10 inches (147cm). In older popular and medical usage, any type of marked human smallness could also be termed dwarfism. People who are affected by dwarfism are often referred to as "little people".^[2]

Dwarfism can be caused by more than 200 different medical conditions. The most common cause of dwarfism is achondroplasia, a bone growth disorder responsible for 70% of dwarfism cases.^[3] Conditions in humans characterized by disproportional body parts are typically caused by one or more genetic disorders in bone or cartilage development. Forms of extreme shortness in humans characterized by proportional body parts usually have a hormonal or nutritional cause such as growth hormone deficiency, once known as "pituitary dwarfism".^[2]

Types of dwarfism

Dwarfism is a broad term that can cover a myriad of conditions. As such, dwarfism's underlying conditions are classified with many different terms.

When the cause of dwarfism is understood, it may be classified according to one of hundreds of names, which are usually permutations of the following roots:

• rhizomelic = root, e.g. bones of upper arm or thigh
• mesomeli = middle, e.g. bones of forearm or lower leg
• acromelic = end, e.g. bones of hands and feet.
• chondro = of cartilage
• osteo = of bone
• spondylo = of the vertebrae
• plasia = form
• trophy = growth

Examples include achondroplasia, osseous dysplasia, chondrodystrophy, and osteochondrodystrophy.^[4]

The most recognizable and most common form of dwarfism is achondroplasia, which accounts for 70% of dwarfism cases and produces rhizomelic short limbs, increased spinal curvature, and distortion of skull growth.^[5] Other relatively common types include spondyloepiphyseal dysplasia congenita (SED), diastrophic dysplasia, pseudoachondroplasia, hypochondroplasia, and osteogenesis imperfecta (OI). Severe shortness with skeletal distortion also occurs in several of the mucopolysaccharidoses and other [[lysosomal storage disease|storage

Terminology

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

"Midget," whose etymology indicates a "small sandfly,"^[6] came into prominence in the mid-1800s 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.^[7]Later,the word was deemed highly offensive because it was the term used to describe P.T. Barnum's dwarfs used for public amusement during the freak show era. ^[2] It is also not considered accurate as it is not a medical diagnosis, though it is sometimes used to describe those who are particularly short but still proportional.^[8]

The term "dwarf" became used to describe those with achondroplasia first notably by the Brothers Grimm in their famous fairy tale Little Snow White, ^[9] although it was used in Jonathan Swift's Gulliver's Travels to describe a giant who was only 20ft tall compared to his 40ft peers.^[10] Dwarf too has been condemned as inaccurate and insensitive because of its mystical and fairy tale history.^[2]

The LPA (Little Peoples of America) deems "little people" the most appropriate description.^[2]

Diagnosis

Unusually being really short for a child's age is usually what brings the child to medical attention. Skeletal dysplasia ("dwarfism") 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. Bone x-rays are often the key to diagnosis of a specific skeletal dysplasia, but they are not the key diagnosis. Most children with suspected skeletal dysplasias will be referred to a genetics clinic for diagnostic confirmation and genetic counseling. In the last decade, genetic tests for some of the specific disorders have become available.^[11]

During the initial medical evaluation for shortness, the absence of disproportion and the other clues above usually indicates other causes than bone dysplasias. Extreme shortness with completely normal proportions sometimes indicates growth hormone deficiency (pituitary dwarfism).^[12]

Short stature alone, in the absence of any other abnormalities, may be the result of the distribution of offspring height from short-statured parents, rather than a symptom of any medical condition.^[13]

Problems associated with dwarfism

The principal adverse effects of dwarfism can be divided into the physical and the social.

Physical effects of malformed bones vary according to the specific disease. Many involve pain resulting from joint damage from abnormal bone alignment, or from nerve compression (e.g, spinal stenosis).^[2]. Early degenerative joint disease, exaggerated lordosis or scoliosis, and constriction of spinal cord or nerve roots can cause pain and disability.^[14] Reduced thoracic size can restrict lung growth and reduce pulmonary function. Some forms of dwarfism are associated with disordered function of other organs, such as the brain or liver, sometimes severely enough to be more disabling than the abnormal bone growth.^[15] As well, many dwarfs are given injections of Human Growth Hormone during their early years, in the hope that it will increase their height, though, sadly, the HGH injections may cause adverse effects on the cardiac muscles, making them too large or thick to properly function, causing death through cardiac failure in the patient.^[16]

The psychosocial disadvantages may be more distressing 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.

• Social prejudice against extreme shortness may reduce social and marital opportunities.^[17][18]

See also: heightism

• Numerous studies have demonstrated reduced employment opportunities. Severe shortness is associated with lower income.^[18]
• Self-esteem may suffer and family relationships affected
• Extreme shortness (in the low 2–3 foot [60–90 cm] range) can interfere with ordinary activities of daily living, like driving or using countertops built for taller people. There are also symptoms with dwarfism such as bowed knees, big head and forehead, back problems, difficulty walking, and unusually short fingers.
• Dwarfism is often misunderstood by others and short people are often believed to be academically challenged, which leads to a difficult social life.^[15]

Treatment and support

There are some forms of dwarfism involved with the endocrine system. If the cause is prepubescent hyposecretion of growth hormone then supplemental growth hormone may correct the abnormality. If there is a problem with the receptor for growth hormone at the tissue level then it is harder to treat. Other endocrine factors that could cause dwarfism is hypothyroidism. The major difference between hyperthyroidism and hyposecretion of growth hormone is symmetry. Deficiencies of growth hormone lead to symmetrical hypoplasia and hyperthyroidism leads to asymmetrical dwarfism with mental retardation. As the genetic defects of most forms of dwarfism due to bone dysplasia cannot be corrected, therapeutic interventions are typically aimed at (1) preventing or reducing pain or physical disability, (2) increasing adult height, or (3) mitigating psychosocial stresses and enhancing social adaptation.^[19]

Pain and disability may be ameliorated by physical therapy, by braces or other orthotic devices, or by surgical procedures.^[19] The only simple interventions that increase perceived adult height are dress enhancements such as shoe lifts or hairstyle. Growth hormone is rarely used for shortness due to bone dysplasias, as the height benefit is typically small (less than 5 cm) and the cost high.^[20] The most effective means of increasing adult height by several inches is limb-lengthening surgery, though availability is limited and cost is high in terms of money, discomfort, and interruption of life. Most people with dwarfism do not avail themselves of this, and it remains controversial.^[2] For other types of dwarfism, surgical treatment is not possible.

Cultural references

The Dwarf Don Sebastián de Morra, by Velázquez. In his portraits of the dwarfs of Spain's royal court, the artist preferred a serious tone.

"Queen Henrietta Maria and the dwarf Sir Jeffrey Hudson",by Anthonis van Dyck, 1633

When depicted in art, literature, or movies, dwarfs are rarely depicted as "regular people who are very short" but often as a species apart. Novelists, artists, and moviemakers attach special moral or aesthetic significance to the "apartness" or the misshapenness.

Artistic representations of dwarfism can be found on Greek vases and other ancient artefacts, including ancient Egyptian art. Documentation of dwarfs can also be found on European paintings and many pictures. Many European paintings (especially Spanish) of the 16th–19th centuries depict dwarfs by themselves or with others. In the Talmud, it is said that the second born son of the Egyptian Pharaoh of the Bible was a dwarf.^[21] Recent scholarship has indicated that the ancient Egyptians esteemed dwarfs. ^[22]

Literature

Several novels have treated dwarfism as a major theme, although not necessarily realistically:

• The Tin Drum (Die Blechtrommel) by Günter Grass. The protagonist, Oskar Matzerath, refuses to grow up and as such goes through many large events in history with the stature of a small child.
• Stones from the River by Ursula Hegi. Trudi Montag is a dwarf who tries to survive in a small town during World War II.
• The Dwarf by Pär Lagerkvist. The entire novel is based around a dwarf protagonist and his life in an Italian city-state.
• A Prayer for Owen Meany by John Irving. Owen Meany, the friend of the narrator and major focus of the story, is a dwarf with a fixed voicebox.
• Hop-Frog, or The Eight Chained Ourang-Outangs by Edgar Allan Poe. The titular character Hop-Frog and his friend Tripetta are both dwarfs.
• A Song of Ice and Fire series by George R.R. Martin. One of the main characters, Tyrion Lannister, is a dwarf who struggles with acceptance by "normal" people.

Film & Television

The actor and stunt man Verne Troyer has become famous playing the character "Mini-Me" in two Austin Powers movies^[23], as has fellow stuntman and Jackass cast-member, Jason "Wee-Man" Acuña.^[24]

In the mid-1970s, Sid and Marty Krofft built an indoor theme park in Atlanta, Georgia called The World of Sid and Marty Krofft. This had a live stage production that was at that time the largest gathering of "little people" since the filming of The Wizard of Oz in 1937-38 as well as being the largest indoor theme park built to that time. The facility that was built to house this theme park is today the studios of CNN, the Cable News Network, and CNN Headline News.^[25]

Actor Peter Dinklage played the lead role of Finbar McBride in the highly acclaimed 2003 film The Station Agent. The movie won Sundance Film Festival awards that year. (Best Drama, Audience Award; Best Screenplay, Tom McCarthy).

In the 1990s, Seinfeld featured a dwarf character, Mickey Abbott, in seven episodes; Mickey was played by actor Danny Woodburn. He got into several physical altercations with 6-foot (1.8 m)-plus Kramer. In one episode, he was ostracized by his dwarf peers for using lifts in his shoes to make him look taller.

The actor Warwick Davis has found success in several notable fantasy franchises, including Star Wars, Harry Potter, Willow, Leprechaun, Gulliver's Travels, The 10th Kingdom,The Hitchhiker's Guide to the Galaxy (film) and The Chronicles of Narnia (both the 1989 television serial and again in the 2008 film version of Prince Caspian).^[26] Actor Tony Cox has appered in several movies like Friday, Bad Santa, and Date Movie Deep Roy is another fellow actor with dwarfism. Roy has acted in many movies such as Star Wars as an Ewok and in his most famous role, all of the Oompa Loompas in Charlie and the Chocolate Factory.^[27].

See also

• Ellis-van Creveld syndrome
• List of people with dwarfism
• Primordial dwarfism
• Psychogenic dwarfism
• Gigantism
• Laron syndrome
• Mulibrey nanism
• Midget

References

External links

• Wheeless Textbook of Orthopedics online has general medical information about various disorders of cartilage and bone formation
• Little People of America
• Restricted Growth Association UK
• Little People: A Father Reflects on His Daughter's Dwarfism — and What It Means to Be Different, by Dan Kennedy. Critically acclaimed book in a free online edition.[[gf:'midgets'