Ewha Med J.  2021 Oct;44(4):111-116. 10.12771/emj.2021.44.4.111.

Approach to Short Stature in Children and Adolescent

Affiliations
  • 1Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

Abstract

Growth represents a sentinel for general health state in children and adolescent. Linear growth in children and adolescent is a complex process influenced by numerous factors including genetic, prenatal, postnatal, and environmental factors. When children less than 2 standard deviation score below the average height for age and sex, they are considered as short stature. Accurate measurement of body profile and determination of height velocity over time are fundamental step. Whether the growth pattern is appropriate or deviated from standardized growth chart is a key point in approaching to short stature in children. Evaluation includes a detailed past medical and family history, physical examination, laboratory test and radiologic evaluation. Recent advances in genetic approaches are allowing for improved diagnosis for idiopathic short stature and various genetic syndromes. Growth hormone is the main treatment option for short stature. It is generally safe but has potential side effects. Individualized growth hormone treatment should be initiated under consideration of both efficacy and safety by pediatric endocrinologists. Early diagnosis and prompt initiation of treatment result in a good prognosis. This article reviews an overview of the diagnostic approach to children and adolescents with short stature, and summarizes etiologies and growth hormone treatment.

Keyword

Anthropometry; Child; Growth; Short; stature

Reference

1. Cheetham T, Davies JH. 2014; Investigation and management of short stature. Arch Dis Child. 99:767–771. DOI: 10.1136/archdischild-2013-304829. PMID: 24599067.
Article
2. Kim JH, Lee JA, Kim DH, Lim JS. 2019; Korean reference for full-term birth length by sex: data from the 4th Korean National Health and Nutrition Examination Survey (KNHANES-IV; 2007-2009). Ann Pediatr Endocrinol Metab. 24:226–230. DOI: 10.6065/apem.2019.24.4.226. PMID: 31905441. PMCID: PMC6944858.
Article
3. Kim S, Choi Y, Lee S, Ahn MB, Kim SH, Cho WK, et al. 2020; Growth patterns over 2 years after birth according to birth weight and length percentiles in children born preterm. Ann Pediatr Endocrinol Metab. 25:163–168. DOI: 10.6065/apem.1938180.090. PMID: 32871654. PMCID: PMC7538305.
Article
4. Wang J, Zhou J, Cheng CM, Kopchick JJ, Bondy CA. 2004; Evidence supporting dual, IGF-I-independent and IGF-I-dependent, roles for GH in promoting longitudinal bone growth. J Endocrinol. 180:247–255. DOI: 10.1677/joe.0.1800247. PMID: 14765976.
Article
5. Meinhardt UJ, Ho KK. 2006; Modulation of growth hormone action by sex steroids. Clin Endocrinol (Oxf). 65:413–422. DOI: 10.1111/j.1365-2265.2006.02676.x. PMID: 16984231.
Article
6. Vogiatzi MG, Copeland KC. 1998; The short child. Pediatr Rev. 19:92–99. DOI: 10.1542/pir.19-3-92. PMID: 9509856.
Article
7. Karlberg J, Jalil F, Lam B, Low L, Yeung CY. 1994; Linear growth retardation in relation to the three phases of growth. Eur J Clin Nutr. 48 Suppl 1:S25–S43.
8. Grunauer M, Jorge A. 2018; Genetic short stature. Growth Horm IGF Res. 38:29–33. DOI: 10.1016/j.ghir.2017.12.003. PMID: 29249624.
Article
9. Tanner JM, Goldstein H, Whitehouse RH. 1970; Standards for children's height at ages 2-9 years allowing for heights of parents. Arch Dis Child. 45:755–762. DOI: 10.1136/adc.45.244.755. PMID: 5491878. PMCID: PMC1647404.
10. Dallora AL, Anderberg P, Kvist O, Mendes E, Diaz Ruiz S, Sanmartin Berglund J. 2019; Bone age assessment with various machine learning techniques: a systematic literature review and meta-analysis. PLoS One. 14:e0220242. DOI: 10.1371/journal.pone.0220242. PMID: 31344143. PMCID: PMC6657881.
Article
11. Choi YJ, Lee YJ, Lee NY, Lee SH, Kim SK, Ahn MB, et al. 2020; Discriminatory performance of insulin-like growth factor 1 and insulin-like growth factor binding protein-3 by correlating values to chronological age, bone age, and pubertal status for diagnosis of isolated growth hormone deficiency. Ann Pediatr Endocrinol Metab. 25:240–247. DOI: 10.6065/apem.2040018.009. PMID: 32871649. PMCID: PMC7788340.
Article
12. Rogol AD. 2011; Clinical and humanistic aspects of growth hormone deficiency and growth-related disorders. Am J Manag Care. 17 Suppl 18:eS4–eS10.
13. Zhou E, Hauser BR, Jee YH. 2021; Genetic evaluation in children with short stature. Curr Opin Pediatr. 33:458–463. DOI: 10.1097/MOP.0000000000001033. PMID: 34101704.
Article
14. Yue S, Whalen P, Jee YH. 2019; Genetic regulation of linear growth. Ann Pediatr Endocrinol Metab. 24:2–14. DOI: 10.6065/apem.2019.24.1.2. PMID: 30943674. PMCID: PMC6449614.
Article
15. Polidori N, Castorani V, Mohn A, Chiarelli F. 2020; Deciphering short stature in children. Ann Pediatr Endocrinol Metab. 25:69–79. DOI: 10.6065/apem.2040064.032. PMID: 32615685. PMCID: PMC7336267.
Article
16. Lindsay R, Feldkamp M, Harris D, Robertson J, Rallison M. 1994; Utah Growth Study: growth standards and the prevalence of growth hormone deficiency. J Pediatr. 125:29–35. DOI: 10.1016/S0022-3476(94)70117-2.
Article
17. Shiva S, Nikzad AR. 2009; Etiology of short stature in East Azerbaijan, Iran. Iran J Pediatr. 19:35–40.
18. Rogol AD, Hayden GF. 2014; Etiologies and early diagnosis of short stature and growth failure in children and adolescents. J Pediatr. 164(5 Suppl):S1–S14. DOI: 10.1016/j.jpeds.2014.02.027. PMID: 24731744.
Article
19. Wit JM, Clayton PE, Rogol AD, Savage MO, Saenger PH, Cohen P. 2008; Idiopathic short stature: definition, epidemiology, and diagnostic evaluation. Growth Horm IGF Res. 18:89–110. DOI: 10.1016/j.ghir.2007.11.004. PMID: 18182313.
Article
20. Raben MS. 1958; Treatment of a pituitary dwarf with human growth hormone. J Clin Endocrinol Metab. 18:901–903. DOI: 10.1210/jcem-18-8-901. PMID: 13563618.
Article
21. Wilson TA, Rose SR, Cohen P, Rogol AD, Backeljauw P, Brown R, et al. 2003; Update of guidelines for the use of growth hormone in children: the Lawson Wilkins Pediatric Endocrinology Society Drug and Therapeutics Committee. J Pediatr. 143:415–421. DOI: 10.1067/S0022-3476(03)00246-4.
Article
22. Seok EM, Park HK, Rho JG, Kum CD, Lee HS, Hwang JS. 2020; Effectiveness of growth hormone therapy in children with Noonan syndrome. Ann Pediatr Endocrinol Metab. 25:182–186. DOI: 10.6065/apem.1938154.077. PMID: 32871657. PMCID: PMC7538297.
Article
23. Kemp SF, Kuntze J, Attie KM, Maneatis T, Butler S, Frane J, et al. 2005; Efficacy and safety results of long-term growth hormone treatment of idiopathic short stature. J Clin Endocrinol Metab. 90:5247–5253. DOI: 10.1210/jc.2004-2513. PMID: 15998780.
Article
24. Cianfarani S. 2019; Risk of cancer in patients treated with recombinant human growth hormone in childhood. Ann Pediatr Endocrinol Metab. 24:92–98. DOI: 10.6065/apem.2019.24.2.92. PMID: 31261472. PMCID: PMC6603614.
Article
25. Gharib H, Cook DM, Saenger PH, Bengtsson BA, Feld S, Nippoldt TB, et al. 2003; American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in adults and children: 2003 update. Endocr Pract. 9:64–76. DOI: 10.4158/EP.9.1.64. PMID: 12917095.
26. Wagner IV, Paetzold C, Gausche R, Vogel M, Koerner A, Thiery J, et al. 2014; Clinical evidence-based cutoff limits for GH stimulation tests in children with a backup of results with reference to mass spectrometry. Eur J Endocrinol. 171:389–397. DOI: 10.1530/EJE-14-0165. PMID: 24966174.
Article
27. Garcia JM, Biller BM, Korbonits M, Popovic V, Luger A, Strasburger CJ, et al. 2018; Macimorelin as a diagnostic test for adult GH deficiency. J Clin Endocrinol Metab. 103:3083–3093. DOI: 10.1210/jc.2018-00665. PMID: 29860473.
Article
28. Yuen K, Miller BS, Biller B. 2018; The current state of long-acting growth hormone preparations for growth hormone therapy. Curr Opin Endocrinol Diabetes Obes. 25:267–273. DOI: 10.1097/MED.0000000000000416. PMID: 29746309.
Article
29. Legeai-Mallet L. 2016; C-type natriuretic peptide analog as therapy for achondroplasia. Endocr Dev. 30:98–105. DOI: 10.1159/000439334. PMID: 26684019.
Article
Full Text Links
  • EMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr