Short Stature in Children
S. Douglas Frasier MD1
1 Professor of Pediatrics and Physiology/Biophysics, University of Southern California School of Medicine, and Chief, Division of Pediatric Endocrinology, Los Angeles County-USC Medical Center, Los Angeles
Short stature in childhood has many possible causes, only the minority of which are endocrine disorders. In addition to a complete history and physical examination, the most important information that can be brought to bear on the differential diagnosis of short stature is accurate serial measurements of length and/or height. When these data are used to calculate growth velocity and are plotted on a standard growth curve, short children can be quickly classified into those growing at a subnormal rate and likely to have a significant underlying problem and those whose growth rate is normal and who are very unlikely to have any problem. In general, diagnostic studies may be limited to short children who are growing at a subnormal rate. Endocrine disease should only be considered after chronic illness of a nonendocrine organ system has been eliminated from consideration. The possibilities of hypothyroidism, an abnormality of the X chromosome in short girls, and growth hormone deficiency should be sequentially evaluated. The unusual diagnoses of deprivation dwarfism and glucocorticoid excess must be kept in mind. If a specific diagnosis is confirmed, appropriate therapy can be instituted. The vast majority of short children are growing at a normal rate and are boys with constitutional delay. A bone age x-ray is extremely helpful in arriving at a prediction of their mature height which is almost always within the range expected in their family. The reassurance provided by this maneuver usually makes any pharmacologic therapy unnecessary.
