1. Short stature
Dr ali mazaheri MD

2. Phases of growth The infantile phase The childhood phase
The pubertal phase

3. Importance of growth monitoring
Normal growth is a sign of good health in children
Monitoring growth allows detection of the causes of poor growth
Early recognition of poor growth allows early intervention

4. height of an individual Depends on
genetics
nutritional status
hormonal milieu
various environmental factors

5. The child should be fully erect, with the head in the Frankfurt plane; the back of the head, thoracic spine, buttocks, and heels should touch the vertical axis of the stadiometer, and the heels should be together.
lengths and heights be measured in triplicate, that variation should be no more than 0.3 cm, and that the mean height should be recorded .

8. definition
A child who is 2 standard deviations (SD) or more below the mean height for children of that sex and chronologic age is said to have short stature.

9. Deviation from normal pattern of growth can be the first manifestation of a wide variety of disease processes, including :
endocrine and nonendocrine disorders .

10. Evaluation of growth Is the child short ?
Does the child have dysmorphic features or disproportionate short stature?
Although the child is short, is his or her growth velocity impaired?

11. Growth chart

12. Short stature =HT<–2 SD (3rd)–3 –2 –1
Mean +1 +2 +3
Increasing
pathology
Short stature
Percentile: 1 3 10 25 50 75 90 97 99
Short stature =HT<–2 SD (3rd) )

13. Height velocity

14. Subnormal growth 1-2 yr < 10 cm 2-3 yr < 7 cm 3-4 yr < 6 cm
4 yr - Puberty < 4 cm

15. Target height is calculated based on midparental height
Target midparental height (boys) = (father’s height + mother's height) Target midparental height (girls) = (father’s height + mother's height) – 6.5 2

18. Clinical assessment of short stature
Family history
Clinical judgement
Auxological data
Decision to investigate
Actual height (cm)
Difference between height and target height SDS
Height velocity (cm/year)
Evaluations

19. Definition of short stature
Normal short stature : Height 1-2 SD below mean.
Short stature ,possibly abnormal : Height 2-3 SD below mean.
Pathologic short stature ,abnormal : Height 3 SD below mean.

20. European Society for Paediatric Endocrinology classification of short stature
Primary growth failure
Clinically defined syndromes, e.g. TS, NS and PWS
SGA
Skeletal dysplasia
Secondary growth failure
Malnutrition
Disorders in organ systems, e.g. renal disorders
GH deficiency
Other disorders of the GH–IGF axis
Other endocrine disorders, e.g. Cushing syndrome
Metabolic disorders
Psychosocial disorders
Iatrogenic disorders, e.g. glucocorticoid therapy and
treatment of childhood malignancy
Idiopathic short stature
Familial short stature
Non-familial short stature

21. Screening Tests CBC BUN , Cr , Na , K , VBG LFT Ca , P U/A , U/C
TTg IgA ab , total IgA
Karyotype (in short girls)
TSH
Bone Age
IGF-1 and IGFBP3
˃ 2 SD below the mean
GH test

22. A family seeks evaluation and treatment of short stature in their 11
A family seeks evaluation and treatment of short stature in their 11.5-year-old son.
He previously was in the 3rd percentile for height, but his growth rate has slowed during the past 2 years.
his height is now just below the 1st percentile

23. His mother is 152 cm, and his father is 167 cm.
His medical history and a review of systems are unremarkable.
His physical examination is normal and shows prepubertal development.
The lab test and growth hormone levels after provocative testing are normal.
His skeletal maturation (bone age) is approximately 9 years.
The child’s size at birth was normal.
his predicted adult height is 165 cm +or- 3.3 cm.

24. Constitutional Delay of Growth
The diagnosis suspected if one or both parents have a history of a late timing of puberty
An increase in growth velocity after treatment with a short course of sex hormone can be against the presence of GHD
Normal growth hormone levels
Height ≤ 3rd percentile but with annual growth rate >5th percentile for age
Delayed puberty
Delayed bone age
Normal predicted adult height

25. Idiopathic Short Stature
ISS is defined as height is ˃2 SD score (SDS) below the mean height for age, sex, and population group
No evidence of systemic, endocrine, nutritional, or chromosomal abnormalities
normal birth weight and are GH sufficient
FDA approved GH treatment (53μg/kg/d) for children shorter than 2.25 SDS
The mean increase in adult height in GH therapy (average duration of 4–7 yr) is 3.5–7.5 cm
An increase in predicted adult height has been shown in males with ISS with aromatase Inhibitor treatment

26. Approximate Projections of the Growth Trajectory and Adult Height
Associated with Various Treatments for Short Stature

27. FDA Approved Indications
CRF
Idiopathic short stature
Prader-Willi syndrome
Noonan syndrome
Turner syndrome
Children with Short Stature Homeobox (SHOX) gene
SGA
AIDS wasting syndrome
Short bowel syndrome
After renal transplant

28. Other indication may not be approved for, but not limited
Anabolic therapy, except for AIDS, provided to counteract acute or chronic catabolic illness
Anabolic therapy to enhance body mass or strength for professional
Constitutional delay of growth and development
Cystic Fibrosis
Growth hormone treatment in combination with GnRH agonist (Lupron) as a treatment of precocious puberty
Hypophosphatemic rickets
Osteogenesis imperfecta
Osteoporosis

29. Other indication may not be approved for, but not limited
Short stature associated with growth hormone insensitivity (Laron Syndrome)
Therapy in older adults with normally occurring decrease in GH, who are not congenitally GH deficient and who have no evidence of organic pituitary disease
Treatment of congestive heart failure (CHF)
Treatment of individuals with burns
Treatment of fibromyalgia
Treatment of glucocorticoid-induced growth failure
Treatment of HIV lipodystrophy
IUGR or Russell-Silver Syndrome
Obesity