What you need to know about Short Stature

Bansot Ba Ang Anak Mo? What you need to know about Short Stature
Erva Magbanua – Maglanque, MD

Is your child unusually short for his age? Have you noticed that he or she is much shorter than his classmates or friends who are of the same age and gender? Has his growth rate decreased or plateaued earlier than expected? Does his clothes last year still fit him comfortably? If you answered yes to any of these questions, your child may be affected by short stature.

SHORT STATURE is a general term for people whose height is significantly below average compared to the height of their peers. The term is more commonly used to refer to children, but this term may also be used in adults.

What causes short stature? The causes of short stature are divided into three broad categories: 1) familial short stature; 2) constitutional growth development, the two more common causes; and 3) chronic disease, which is the least common.

I. FAMILIAL SHORT STATURE If one or both parents are short, there is a strong likelihood that their child will also be short. The hallmarks of familial short stature or genetic short stature include bone age appropriate for chronologic age, normal growth velocity, and predicted adult height appropriate to the short stature familial pattern. A child with familial short stature is considered healthy if either parent’s short stature is not due to any other medical condition.

II. CONSTITUTIONAL GROWTH DELAY Constitutional growth delay (a.k.a the late bloomer) is characterized by delayed bone age; with normal growth velocity and predicted adult height appropriate to the familial pattern. Children affected typically have a first- or second-degree relative with constitutional growth delay. These children are small for their age and often enter puberty at a later age. Fortunately, they will continue to grow after their peers have stopped and they usually catch up by adulthood, reaching their expected target height.

Turner Syndrome

Sexual Precocity

Sexual Precocity

III. CHRONIC DISEASES A number of diseases can cause unusually short stature. These diseases fall into several categories: undernutrition, endocrine causes, chronic systemic illness (diseases of other parts of the body that can affect the rest of the body), and genetic disorders.

A. Undernutrition can lead to short stature due to prolonged inadequate food intake, improper feeding practices, and frequent illness. Undernutrition causes stunted growth associated with impaired cognitive ability and reduced school and work performance.

B. Endocrine diseases affect hormone production and, oftentimes, height as well.

Hypothyroidism is a disorder in which the thyroid gland does not produce enough thyroid hormone. Mild to moderate growth failure may be the most prominent manifestation of acquired hypothyroidism in children, whereas more severe growth failure, may be a result of untreated congenital hypothyroidism.

Growth Hormone Deficiency (GDH) usually results from a deficiency in the release of growth hormones by the pituitary gland. In rare cases, brain tumors may damage the pituitary glands leading to a deficiency of growth hormones.

Cushing Syndrome (CS) results from prolonged exposure from glucocorticoids or steroids. This impairs skeletal growth and interferes with normal bone metabolism. In childhood, lack of height gain consistent with the weight gain is the most common manifestation of CS. Other common manifestations include puffiness and redness of the cheeks, hypertension, excessive facial hair, absence of menstruation, and delayed sexual development.

Diabetes Mellitus – Growth failure can occur in Type 1 diabetic children with long-standing poor blood sugar control.

Rickets or vitamin D deficiency causes short stature. Manifestations of rickets include bossing of the forehead and bowing of the legs.

Sexual precocity is defined as the appearance of secondary sexual characteristics before the normal age for puberty. As a result, they experience a growth spurt at a younger age as compared to their peers, but they will also stop growing at an earlier age. These tall children will eventually be short adults because premature puberty causes the growth plate of the bones to close. This stops linear growth, and they fail to reach their expected target height.

Karyotype 47, XY + 21

C. Chronic diseases. Almost any serious systemic disease can cause growth failure. These include heart disorders, inflammatory bowel disease, celiac disease, kidney problems, sickle cell anemia, and juvenile idiopathic arthritis.

D. Genetic conditions. A variety of genetic syndromes and congenital malformations are associated with short stature.

Down syndrome is probably the most common chromosomal disorder associated with growth retardation. Growth failure is associated with delayed skeletal maturation and a delayed and incomplete pubertal growth spurt.

Turner syndrome is a chromosomal condition that affects development in females. The most common manifestation is short stature, which usually becomes evident by the age of 3 years as a slowing down of growth. Other manifestations include webbing of the neck, low posterior hairline, low set ears, cardiovascular abnormalities, lack of puberty and infertility.

How do doctors diagnose short stature?

Your child’s height, weight, and limb length will be recorded serially to determine height velocity using a growth chart. Your family and your child’s medical history will be asked:

  • average height of both parents
  • age of start of puberty for both parents
  • history of medical diseases
  • your child’s birth history (e.g. prematurity)
  • patterns in your child’s growth
  • your child’s diet
  • presence of other symptoms

The following tests may be requested:

  • an x-ray of the growth plates in the hand to check bone age
  • blood tests to check for any diseases and problems in thyroid, liver, kidney, etc.
  • a screening for growth hormone deficiency
  • a DNA analysis (karyotyping) to check for genetic diseases
  • imaging scans to look for tumors

Rickets

What are the treatment options for short stature?

Treatment for short stature depends on the cause. Not all patients with short stature require treatment, though. For children who are naturally short (i.e. familial short stature or constitutional growth delay), no treatment is necessary. Thyroid hormone replacement can be used to treat hypothyroidism. Growth hormone injections can be used to treat GHD and a few other conditions, including Turner syndrome. In brain tumors, surgery may be necessary.

Down Syndrome

What’s the prognosis?

People who have a naturally short stature that is not due to a medical condition or disease can expect to lead normal and healthy lives. Children with GHD and other hormone-related conditions generally reach average height or a height similar to their parents if they receive proper treatment before puberty. For those with genetic or skeletal diseases, short stature will likely be a permanent issue.

Even though short stature may be permanent in some cases, it should not prevent anyone from living a full and extraordinary life. Height is just but one facet of a person and does not define his totality. Parents should take comfort in the words of JRR Tolkien, “Even the smallest person can change the course of the future.”

Bansot Ba Ang Anak Mo? What you need to know about Short Stature
Erva Magbanua – Maglanque, MD

Part of the March 2020 Endocrine Hotspots Edition

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