Short Stature
Short Stature: Excerpt from In A Page: Pediatric Signs and Symptoms
By definition, 3% of normal children are short: A height 2 standard deviations (SD) below the mean for age. Dwarfism is defined as height more than 3 SD below the mean; midget is a dwarf with normal body proportions. Growth failure (worth careful evaluation) defined as: (1) height below 2 SD from the mean for reference population,
(2) height less than 2 SD below midparental target, (3) subnormal growth velocity (2 inches or 5 cm per year from age 3 years to puberty), or (4) growth deceleration (falling across major percentiles on growth curve).
Differential Diagnosis
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Familial short stature
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Constitutional delay of growth and puberty
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Hypothyroidism
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Growth hormone deficiency (GHD)
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GH resistance (Laron syndrome)
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Congenital hypopituitarism
–Secondary to brain tumors
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Acquired hypopituitarism
–After irradiation, surgery, and chemotherapy for neoplasms
–Infectious
–Infiltrative
–Vascular
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Cushing syndrome
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Precocious puberty
–Tall initially
–Final height compromised
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Pseudohypoparathyroidism
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Rickets
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Genetic syndromes
–Turner syndrome
–Down syndrome
–Noonan syndrome
–Prader-Willi syndrome
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Intrauterine growth retardation
–Silver-Russell syndrome
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Disorders of bone development
–Achondroplasia/hypochondroplasia
–Chondrodystrophies
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Psychosocial deprivation
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Malnutrition
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Chronic drug intake
–Glucocorticoids
–Methylphenidate
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Infectious
–HIV
–Tuberculosis
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Congenital heart disease
-
Gastrointestinal
–Celiac disease
–Inflammatory bowel disease
–Chronic liver disease
-
Pulmonary
–Cystic fibrosis
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Chronic renal disease
–RTA
–Renal failure
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Skeletal disorders
Workup and Diagnosis
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History
–Neonatal hypoglycemia or jaundice, brain tumor or other malignancy and treatment, central nervous system infection, nutrition status, chronic illness
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Family history
–Parents’ heights and puberty ages to judge child's growth relative to genetic potential (midparental target height), family history of chronic disease or endocrinopathy
-
Physical exam
–Anthropometrics (height, weight, sitting height), dysmorphic features, craniofacial midline abnormalities (pituitary disease), dentition maturation (delayed in hypothyroidism), chronic illness, Tanner staging for pubertal assessment, micropenis in boys (growth hormone deficiency)
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Bone age X-ray to evaluate skeletal maturation
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Labs
–CBC with differential cell count, LFT, BUN, Cr, electrolytes
–ESR, TSH, T4
–Growth factors (IGF-I, IGFBP-3)
–Celiac antibody panel (anti-tissue transglutaminase)
–Karyotype in girls to rule out Turner syndrome
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If IGF-I and/or IGFBP-3 low, provocative growth hormone test to confirm GHD (must fail two tests)
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MRI of the brain with special cuts of the pituitary in any child diagnosed as having GHD
Treatment
-
Treat the underlying condition
-
Growth hormone therapy
–Indicated in GHD and some other forms of short stature (renal failure, Turner syndrome, Prader-Willi syndrome, small-for-gestational age without catch-up growth)
–Earlier initiation to optimize final height outcome
–Nightly subcutaneous administration of GH at 25–50 µ
g/kg/day
-
Monitor for loss of other pituitary hormones and replace all deficiencies
-
Monitoring growth hormone therapy
–Close follow-up with pediatric endocrinologist every
3–6 months
–Monitor side effects of GH treatment
–Monitor serum IGF-I and IGFBP-3 levels
–Dose adjustments based on IGF values and growth
response
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
More About Short Bowel Syndrome
More Medical Textbooks Online about Short Bowel Syndrome
Review other book chapters online related to Short Bowel Syndrome:
Medical Books Excerpts
- Shortness of Breath
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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» Next page: Shortness of Breath (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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