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Approach to Short Stature

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Dr Jayaprakash P, Kochi    20 November 2018

  1. Shortness is defined as, “below 3rd percentile or 2 SD below the mean;’ excessively short for MPF or TH; or growth velocity <25th percentile over 1 year.
  2. Various growth charts are available: Growth standards, growth references, WHO charts, CDC charts, Agarwal charts, Khadilkar charts. Physical examination includes height, weight, height age, weight age, midparental height, target height, US:LS, arm span and examination of head, eyes, neck, mouth, hand, SMR and systems.
  3. Immediate evaluation is required in following cases: Severe short stature: height >3 SD below the mean; Height >1.5 SD below MPH; Height >2 SD below the mean and a height velocity over 1 year >1 SD below the mean for chronological age; Decrease in height SD of >0.5 over 1 year in children over 2 years of age.
  4. CDGP: Children born with normal weight and length; growth decelerates in 2nd and 3rd year to reach below 3rd percentile; puberty and growth spurt delayed; bone age delayed; males fail to achieve tanner G2 by 14 years and females B2 by 13 years.
  5. Pubertal assessment is recommended for all children more than 6 years of age. Bone age gives information about skeletal maturity, correlates closely with SMR, informs about growth potential and helps in prediction of adult height. IGF-I assays are dependent on age, puberty, bone age and nutrition; they have low sensitivity but high specificity in younger age.
  6. IGFBP3 assays are constant, with higher levels, no BP interference, valuable at young ages and not dependent on nutrition. GH provocation tests exclude hypothyroidism. Long-acting GH preparations comprise of depot formulations, PEGylated formulations, Prodrug formulations, Noncovalent albumin-binding GH compound and GH fusion proteins.

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