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{{about|the medical condition|the legendary creature|dwarf|[[insular dwarfism]] and other uses|Dwarf (disambiguation)}}
{{Infobox Disease
 | Name = {{PAGENAME}}
 | Image = Warwick_Davis_interviewed_2.jpg
 | Caption = [[Warwick Davis]], an English actor with dwarfism.
 | DiseasesDB     = 80
 | ICD10 = {{ICD10|E|23|0|e|20}}, {{ICD10|E|34|2|e|20}}, {{ICD10|E|45|0|e|40}}, {{ICD10|Q|77|4|q|65}}
 | ICD9 = {{ICD9|253.3}}, {{ICD9|259.4}} 
 | ICDO           = 
 | OMIM           = 
 | MedlinePlus    = 001176
 | eMedicineSubj  = 
 | eMedicineTopic = 
 | MeshID         = 
}}

'''Dwarfism''' ({{pronEng |ˈdwɔrfɪzəm}}) is a medical condition in humans characterized by extreme small size. The most widely accepted definition in medical biology for 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.<ref name="LPA">{{cite web  | title = Dwarfism Resources: Frequently Asked Questions  | publisher = Little People of America  | date = 2006-[[July 9|7-9]]  | url = http://www.lpaonline.org/resources_faq.html | archiveurl = http://web.archive.org/web/20060516011550/http://www.lpaonline.org/resources_faq.html | archivedate = 2007-07-12 | accessdate = 2006-11-14}}</ref>

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. Conditions in humans characterized by ''disproportional'' body parts are typically caused by one or more [[genetic disorder]]s in bone or cartilage development. Achondroplasia is an example of disproportional dwarfism. Forms of extreme shortness in humans characterized by ''proportional'' body parts usually have a hormonal or nutritional cause. An example is [[growth hormone deficiency]], once known as "pituitary dwarfism".<ref name="LPA"/><ref name="urlMedlinePlus: Dwarfism">{{cite web |url=http://www.nlm.nih.gov/medlineplus/dwarfism.html |title=MedlinePlus: Dwarfism |date=2008-08-04|publisher=National Institute of Health|format= |work=MedlinePlus |accessdate=2008-10-03}}</ref>

==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]].<ref name="titleDwarfism and Dysplasias - Wheeless' Textbook of Orthopaedics">{{cite web |url=http://www.wheelessonline.com/ortho/dwarfism_and_dysplasias |title=Dwarfism and Dysplasias - Wheeless' Textbook of Orthopaedics |accessdate=2007-12-07 | date=2006-06|publisher=Duke Orthopaedics|format= |work=Wheeless' Textbook of Orthopaedics}}</ref>

The most recognizable and most common form of dwarfism is [[achondroplasia]], which produces rhizomelic short limbs, increased spinal curvature, and distortion of skull growth.<ref name="urlAchondroplasia - Genetics Home Reference">{{cite web |url=http://ghr.nlm.nih.gov/condition=achondroplasia |title=Achondroplasia - Genetics Home Reference |date=2008-09-26|format= |work=Genetics Home Reference|publisher=National Institute of Health |accessdate=2008-10-01}}</ref> It accounts for 70% of dwarfism cases. 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 [[mucopolysaccharidosis|mucopolysaccharidoses]] and other [[lysosomal storage disease|storage diseases]].

The average adult height of male and females with dwarfism is 132 cm and 123 cm respectively. The average weight of an adult may range from 100 to 150 pounds (45-68 kg).<ref name="urlAchondroplasia - Genetics Home Reference"/>

== Diagnosis ==
Unusually short stature 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.

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).''

Short stature alone, in the absence of any other abnormalities, may simply be genetic, particularly if a person is born into a family of people who are relatively short.

== 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]]).<ref name="LPA"/>. Early degenerative joint disease, exaggerated [[lordosis]] or [[scoliosis]], and constriction of [[spinal cord]] or nerve roots can cause pain and disability. Reduced [[thorax|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. As well, many dwarves 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.

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.<ref name="isbn0-8018-8121-8">{{cite book |author=Hall, Judith A.; BETTY M. ADELSON |title=Dwarfism: medical and psychosocial aspects of profound short stature |publisher=Johns Hopkins University Press |location=Baltimore |year=2005 |pages= |isbn=0-8018-8121-8 |oclc= |doi= |accessdate=}}</ref><ref name="pmid12884421">{{cite journal |author=Gollust SE, Thompson RE, Gooding HC, Biesecker BB |title=Living with achondroplasia in an average-sized world: an assessment of quality of life |journal=American journal of medical genetics. Part A |volume=120A |issue=4 |pages=447–58 |year=2003 |month=August |pmid=12884421 |doi=10.1002/ajmg.a.20127 |url=http://dx.doi.org/10.1002/ajmg.a.20127}}</ref> {{seealso|heightism}}
* Numerous studies have demonstrated reduced employment opportunities. Severe shortness is associated with lower income.<ref name="pmid12884421" />
* [[Self-esteem]] may suffer and family relationships affected
* Extreme shortness (in the low 2&ndash;3 foot [60&ndash;90&nbsp;cm] range) can interfere with ordinary activities of daily living, like driving or even 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.

==Treatment and support==
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.  

Pain and disability may be ameliorated by physical therapy, by braces or other orthotic devices, or by surgical procedures. 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. 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.<ref name="LPA"/> For other types of dwarfism, surgical treatment is not possible.

==Cultural references==
{{Cleanup-laundry|section|date=January 2008}}
{{trivia|date=March 2008}}
[[Image:velazquez-dwarf-don-sebastian-de-morra.jpg|right|thumb|''The Dwarf Don Sebastián de Morra'', by [[Diego Velázquez|Velázquez]]. In his portraits of the dwarves of Spain's royal court, the artist preferred a serious tone.]]
[[Image:Anthonis van Dyck 013.jpg|thumb|right|200px|"[[Queen Henrietta Maria]] and the dwarf [[Sir Jeffrey Hudson]]",by [[Anthonis van Dyck]], 1633]] 
When depicted in art, literature, or movies, dwarves are rarely depicted as "regular people who are very short" but often as a species apart. [[Novelist]]s, [[artist]]s, and [[film-maker|moviemaker]]s attach special moral or aesthetic significance to the "apartness" or the misshapenness.

Artistic representations of dwarfism can be found on [[ancient Greece|Greek]] vases and other ancient artefacts, including [[ancient Egypt]]ian art. Documentation of dwarves can also be found on European paintings and many pictures. Many European paintings (especially [[Spain|Spanish]]) of the 16th&ndash;19th centuries depict dwarves by themselves or with others.
In the [[Talmud]], it is said that the second born son of the [[Egypt]]ian [[Pharaoh]] of the [[Bible]] was a dwarf.<ref>[http://www.sacred-texts.com/jud/pol/pol09.htm The Talmud - CHAPTER VI. DEATH OF JACOB AND HIS SONS--MOSES--THE DELIVERANCE FROM EGYPT.] URL accessed April 23, 2007</ref> Recent scholarship has indicated that the ancient Egyptians esteemed dwarves. [http://news.bbc.co.uk/2/hi/health/4554824.stm]

In [[Jonathan Swift]]'s "''[[Gulliver's Travels]]''", the protagonist encounters in the court of the Giants' Kingdom the strong enmity of the local "dwarf", who is "only" twenty feet high (where normal giants measure forty feet) and resents being displaced by "a smaller dwarf".   

Several novels have treated dwarfism as a major theme, although not necessarily realistically:
* ''[[The Tin Drum]]'' (''Die Blechtrommel'') by [[Günter Grass]]
* ''[[Stones from the River]]'' by [[Ursula Hegi]]
* ''[[The Dwarf]]'' by [[Pär Lagerkvist]]
* ''[[A Prayer for Owen Meany]]'' by [[John Irving]]
* ''[[A Son of the Circus]]'' by John Irving
* "[[Hop-Frog|Hop-Frog, or The Eight Chained Ourang-Outangs]]" by [[Edgar Allan Poe]]
* ''[[Maybe the Moon]]'' by [[Armistead Maupin]]

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

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 (1939 movie)|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 ''[[Headline News|CNN Headline News]]''.

In the 1990s, ''[[Seinfeld]]'' featured a dwarf character, [[List of Seinfeld minor characters#mickeyabbott|Mickey Abbott]], in seven episodes; Mickey was played by actor [[Danny Woodburn]]. He got into several physical altercations with {{convert|6|ft|m|sing=on}}-plus Kramer. In one episode, he was ostracized by his dwarf peers for using lifts in his shoes to make him look taller.

Arguably the most famous dwarf actor is [[Warwick Davis]], having 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]]). [[Deep Roy]] is also another fellow actor with dwarfism. Roy has acted in many movies such as [[Star Wars]] as an Ewok and in his most famous role, an Oompa Loompa in Charlie and the Chocolate Factory.

In [[George R.R. Martin]]'s ''[[A Song of Ice and Fire]]'' series, one of the main characters, [[Tyrion Lannister]], is a dwarf. Though a brilliant and well-read man (some would say genius), he struggles with acceptance by "normal" people, who pejoratively refer to him as "the Imp", or "half-man". This is especially true of his father, Lord [[Tywin Lannister]], who holds Tyrion in contempt, especially when compared to Tyrion's handsome, talented older brother Jaime, and Jaime's equally beautiful and talented twin sister, Cersei. Tyrion often wonders if any woman could ever truly love him in spite of his condition.

== See also ==
* [[Ellis-van Creveld syndrome]]
* [[List of people with dwarfism]]
* [[Primordial dwarfism]]
* [[Psychogenic dwarfism]]
* [[Gigantism]]
* [[Laron syndrome]]
* [[Mulibrey nanism]]
* [[Midget]]

==References==
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== External links ==
{{Wiktionarypar2 |dwarf}}
* [http://www.wheelessonline.com Wheeless Textbook of Orthopedics online] has general medical information about various disorders of cartilage and bone formation
* [http://www.lpaonline.org/ Little People of America]
* [http://www.restrictedgrowth.co.uk/ Restricted Growth Association UK]
* [http://www.littlepeoplethebook.com/ <I>Little People: A Father Reflects on His Daughter's Dwarfism — and What It Means to Be Different</I>], by Dan Kennedy. Critically acclaimed book in a free online edition.

[[Category:Growth disorders]]
[[Category:Human height]]

[[da:Dværg (menneske)]]
[[de:Minderwuchs]]
[[es:Enanismo]]
[[eo:Naneco]]
[[fr:Nanisme]]
[[it:Nanismo]]
[[he:גמדות]]
[[ja:小人症]]
[[no:Dvergvekst]]
[[pl:Karłowatość]]
[[pt:Nanismo]]
[[ru:Карлик]]
[[sk:Nanizmus]]
[[fi:Lyhytkasvuisuus]]
[[sv:Dvärgväxt]]
[[zh:侏儒症]]