Short Stature

last authored: Oct 2009, David LaPierre

 

 

Introduction

Short stature is defined as a height <3rd percentile, height crossing two major lines, ir low growth velocity (<25th percentile).

 

 

The Case of...

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Differential Diagnosis

ABCDEFG

  • alone
  • bone dysplasias
  • chromosomal
  • delayed growth
  • endocrine
  • familial
  • GI

Normal

delayed puberty

family of short people

 

Psychosocial neglect

can be eating well, but need happy people to grow

 

Chronic disease: weight > height

congenital heart disease

celiac disease

inflammatory bowel disease

cystic fibrosis

chronic infections

chronic renal failure

juvenile idiopathic arthritis

 

 

Primordial: height, weight and HC

chomosomal: Turner, Down syndrome

skeletal dysplasia: rickets, scoliosis, achondroplasia, mucopolysaccaridosis

IUGR: teratogens, placental insufficiency, infection

 

 

Endocrine: height > weight

GH deficiency

hypothyroidism: low growth, dry skin, no energy

hypercortisolism

hypopituitarism, cortisol excess (Cushing's, most often iatrogenic)

 

 

 

 

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History and Physical Exam

  • history
  • physical exam

History

Perinatal history (IUGR present?)

medical history

parental height and age of puberty

Physical Exam

Growth curves

Tanner staging

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Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

Is this a normal variant, or is it pathological?

  • CBC, ESR - anemia, inflammatory
  • BUN, creat, lytes, alb
  • urinalyis
  • TSH
  • bone age
  • karyotype for girls for 45X0
  • IgA, TTA? for celiac

measuring random GH is not useful.

Diagnostic Imaging

bone age

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Management

 

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Pathophysiology

Why do we stop growing?

growth plate fusion.. mediated by estrogen.

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Resources and References

 

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Topic Development

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