n CME : Your SA Journal of CPD - Short stature in children : main article

Volume 24, Issue 7
  • ISSN : 0256-2170



Linear growth in childhood is one the most sensitive indicators of health and is controlled by multiple factors, i.e. genetic, nutritional, environmental, endocrine, and psychosocial. <BR>Short stature is defined as a height more than 2 SDs below the mean when compared with age and sex-specific standards based on a population of normal healthy children. <BR>The assessment of growth is central to the diagnosis of short stature and this involves height, weight, body proportion, growth velocity, and prediction of adult height assessments. <BR>There are 2 normal variants of growth presenting with short stature - familial short stature and constitutional delay. <BR>The aetiology of pathological short stature includes congenital abnormalities, skeletal dysplasias, malnutrition, chronic illnesses, endocrine disorders, psychosocial deprivation, idiopathic, and iatrogenic causes. <BR>The initial laboratory investigations performed are primarily to exclude the presence of chronic illnesses in patients with auxologically established short stature. In the absence of these causes, the hypothalamic-pituitary-IGF axis is then investigated for GHD as a cause for the short stature. <BR>The random sampling of growth hormone is unhelpful in the diagnosis of growth deficiency, and therefore growth hormone stimulation testing is generally conducted. <BR>Currently there are many controversies about GHST, i.e. standardisation of protocols, stimulatory agents, and interpretation of the GH response, and it is therefore suggested that insulin-like growth factor-1(IGF-1) and / or insulin-like growth factor-binding protein 3 (IGF-BP3) concentrations be used to screen for GHD. <BR>As the diagnosis of short stature is multidisciplinary, high-resolution neuroimaging and genetic studies are recommended in these patients. <BR>GH therapy is recommended for patients with proven GHD and idiopathic short stature, with the primary aim of treatment being normalisation of height during childhood and attainment of normal adult height.

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