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Growth (including short stature and tall stature) 

Growth (including short stature and tall stature)
Chapter:
Growth (including short stature and tall stature)
Author(s):

Gary Butler

and Jeremy Kirk

DOI:
10.1093/med/9780198786337.003.0001
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date: 31 July 2021

Growth occurs in three separate phases, all of which are under different nutritional and/or hormonal controls:

infantile (mainly nutritional)

childhood (hormonal, mainly growth hormone (GH))

pubertal (hormonal; GH and sex steroids acting synergistically).

Height:

should be measured supine up until 2 years of age, and standing after that, and plotted on appropriate charts

is a normally distributed variable, with extremes (0.4th/2nd centiles and 99.6th/98th centiles) arbitrarily defined as short and tall stature respectively.

Two major sets of genes determine height and rate of development; the first is assessed using mid-parental and target height, and the second using bone age.

Short stature:

Failure to achieve an acceptable height can be due to a primary growth problem, or secondary to an underlying disorder.

Causes include familial, genetic disorders (syndromic), small birth size, chronic illness, psychological, environmental, and endocrine.

Generally, short stature due to a hormonal issue is associated with (relative) overweight, and that due to an underlying chronic disorder with (relative) underweight.

GH therapy is licensed for short stature in children in the following situations: GH deficiency, Turner syndrome, chronic renal insufficiency, children born small for gestational age, Prader–Willi syndrome, and SHOX deficiency.

Tall stature:

Although in theory this should present as frequently as short stature, in practice this is not the case.

The commonest cause of tall stature is constitutional, although other forms include:

syndromic: e.g. Klinefelter, Marfan, and Sotos syndromes

hormonal: GH, sex steroid excess.

Therapy (sex steroids, GH blockade, epiphyseal stapling) is less effective than in short stature.

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