Letter to the Editor: History and clinical implications of PAPP-A2 in human growth: When reflecting on idiopathic short stature leads to a specific and new diagnosis Understanding the concept of low IGF-I availability

As a result of our publication of the first patients with short stature due to a mutation in the gene for PAPP-A2 the question, Why did you continue to study these patients when they were not more than 2 SDS below normal? has been proposed surprisingly frequently. We would like to communicate our opinions on why these patients were studied and share the experience on how this process took place. In addition, the choice of treatment is also discussed. We believe that this discovery process is a good example of good clinical practice and international collaboration.