Short Stature

Basics

DESCRIPTION

  • Short stature is height 2 standard deviations (SD) or more below mean or <3rd percentile for age and sex of the normal population.
  • Growth failure is defined as height 2 SD or more, below midparental height (MPH), or height velocity (HV) <10th percentile for age resulting in downward crossing of height percentiles.
  • The majority of children with short stature are essentially healthy. Conversely, true growth failure is typically pathologic and requires evaluation.
  • Failure to thrive (FTT) is failure of appropriate weight gain (decreasing weight to height ratio); may be accompanied by poor linear growth

RISK-FACTORS

  • Poor nutrition, systemic chronic illness, certain medications, and psychosocial factors can all contribute to the clinical presentation of short stature or growth failure.
  • A family history of short stature or delayed growth and puberty are well-established risk factors for childhood short stature.

PATHOPHYSIOLOGY

  • Adequate nutrition and weight gain play major roles in linear growth during childhood.
  • Throughout infancy and childhood, growth hormone (GH) and thyroid hormone exert major influences on normal growth.
  • Pulsatile GH release stimulates insulin-like growth factor 1 (IGF-1) secretion from the liver and other tissues to promote growth at growth plates.
  • The pubertal growth spurt is largely mediated by androgen and estrogen activity at the growth plate as well as enhanced GH release.
  • Chronic illnesses can cause growth failure.
  • Glucocorticoid excess inhibits growth through downregulation of the GH/IGF-1 axis and suppresses osteogenesis.
  • Although boys are more frequently referred for short stature, girls are more likely to have a pathologic reason for short stature.

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