Short stature

• generally throught to be an issue if:

  • males \<162.6 (5’4”)

  • females \<152.4 (5’0”)

• genetic

• nutritional

• hormonal

  • insulin-like growth factor 1

  • thyroxine

  • cortisol

  • sex steroids

• causes:

  • constitutional delay

    • common normal varient

    • growth spurt later

    • bone age delayed

  • familial short stature

    • follows family trend

    • determine parentl height

      • boys - average + 7cm

      • girls - average - 7cm

  • organic causes

    • coeliac

    • Chron’s disease

    • CKD

  • syndromic

    • achondroplasia

      • not aassociated with delayed puberty

      • short upper arms

      • frontal bossing

      • lumbar lordosis

      • trident hands

        • clost proximity between 3rd and 4th fingers and wide spaces between 2nd/3rd and 4th/5th fingers

• investigation: if growth velocity \<25th centile:

  • TSH

  • FBC and ESR/CRP

  • coeliac disease tests

  • chromosones (girls)

  • growth hormone studies

  • kindney function

  • bone age XR

    • left wrist and hand

    • may negate need for growth hormone studies

Tall stature

causes:

• familial

• precocious puberty

• growth hormone excess

• hyperthyroidism

• syndromic

  • marfan

  • Klinefelter

  • XYY

  • homocystinuria

Managmeent:

• high-dose oestrogen used in very tall girls

  • accelerates epiphyseal maturation and reduces final height

• high dose testosterone

  • boys