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Short Stature : Causes, Diagnosis, Approach, & Treatment

Short Stature & Constitutional Delay in Growth : Definition, Causes, Diagnosis, Approach, Evaluation, Management, & PPT

Short Stature

Definition

Height of age below 3rd centile

OR

Height for age below -2 standard deviation of mean

Note: Dwarfism if height for age below -3 standard deviation of mean

Short Stature

Causes

Physiological (Normal growth velocity) Pathological (Abnormal growth velocity)
Constitutional delay in growth Nutritional
Familial short stature Endocrine e.g. GH deficiency, hypothyroidism
Chronic diseases e.g. TB, CKD
Syndromes e.g. Down & turner
Skeletal dysplasia e.g. achondroplasia
Psychosocial factors

Treatment

  • Cause should be undertaken.

Types of age

  • Chronological age (CA)
  • Bone age (BA)
  • Height age (HA)

A. Short stature

  • Chronological age > Bone age or Height age or Both

B. Height estimation

  • Whenever Bone age > Height age

Ultimate height is less

  • Whenever Height age > Bone age

    Ultimate height is better

C. Constitutional delay in growth

  • Chronological age > Bone age = Height age

D. Familial short stature

  • Chronological age = Bone age > Height age

E. Hypothyroidism

  • Chronological age > Height age > Bone age (Better height attained)

F. Growth hormone (Gh) deficiency

  • Chronological age > Bone age > Height age

Constitutional Delay In Growth

  • Most common cause of short stature in children.

At birth, normal height & normal weight

Fail to gain height in first 1-2 year of age

Subsequent growth velocity is normal

  • During entire childhood, height for age remains below -2 standard deviation.

Puberty delayed

Pubertal growth spurt delayed

Pubertal growth spurt is significantly high

Ultimate height is normal

  • Chronological age > Bone age = Height age
  • Serum IGF-1 levels are low for chronological age but normal for bone age.

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