Short Stature

Question 1

The other of an 11-year-old girl brings her to you as she is concerned that she is not as tall as her friends. Her height is 126cm (below 3rd centile) whilst her weight is 31kg (10th gentile) and head circumference is 52cm (2th gentile). Her mother’s height is 160cm and her fathers height is 175cm. Her mother also noticed that she can share clothes with her 8 year old sister and that they are of similar height.

Answer 1

Impression
Concerned about short stature in this 11-year old girl.

Differentials worth considering are;
Normal variants of growth:
- familial: unlikely given parent’s heights
- constitutional: just delayed growth and will likely reach normal adult height
- idiopathic short stature

Pathological causes:
- hypogonadism
- systemic steroid adminstration
- systemic chronic illness: renal, cardiac, liver, rheumatological, etc
- genetic: Turner’s syndrome, Down syndrome, etc

Also concerned about eating disorders and other psychiatric prevention

Question 2

Short Stature - History

Answer 2

History
- assess growth over past few years, check against previous blue-book measurements, diet (SCOFF questionnaire), exercise.
- ask about family growth, anyone late growers?
- features of hypothyroid, cushings
- menstrual history (growth spurt is prior to periods), any other puberty changes (thelarche, pubarche, etc)
- psych: mood, past psych diagnoses, - HEADSSS assessment
- PMHx: chronic diseases, regular medications (steroids, , allergies, etc
- paeds history, developmental, vaccinations, obstetric/antenatal history

Question 3

Short stature - Examination

Answer 3

Examination
- Vitals, general appearance
- Growth parameters, compare with previous charts fro velocity
- Tanners puberty stage assessment
- evidence of dysmorphic features
- Systems review for systemic disease; evidence of thyroid, cushings disease, etc

Question 4

Short stature - Investigations

Answer 4

Investigations
Key
- Bone age: x-ray of non-dominant hand and wrist
o reduced bone age is either constitutional or pathological
o constitutional is

• Bloods: hormone panel (LH, FSH, PRL, TFTs, ACTH, etc), FBC, CRP, ESR, CMP, LFT
• genetic tests: karyotyping, CMA
• consider further imaging for ?intracranial lesion

Question 5

Short stature - management

Answer 5

Management
Ultimately depends on the underlying cause
- likely referral to paeds endocrine for definitive management for any non-constitutional/familial causes

Supportive
- Patient and family education - likely non-pathological, patient should grow eventually.
- continue to monitor growth, regular review

Idiopathic short stature
- if height <1st percentile is indication
- consider GH therapy if NOT constitutional delay
o best outcome if started earlier before puberty
o likely to still be short, only adds 4-10cm if delayed starting