eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Short Stature: Follow-up

Author: Robert J Ferry Jr, MD,, Chief, Division of Pediatric Endocrinology and Metabolism, Le Bonheur Children's Medical Center, University of Tennessee Health Science Center at Memphis, and St. Jude Children's Research Hospital; Brigade Surgeon, 36th Sustainment Brigade, 13th Expeditionary Sustainment Command, U.S. Army
Contributor Information and Disclosures

Updated: Aug 4, 2009

Follow-up

Further Inpatient Care

  • Although many hospitalized patients are short, therapy directed at the illness underlying their short stature is the best course in the inpatient setting.

Further Outpatient Care

  • The proper evaluation of short stature is conducted in an outpatient setting with a calibrated stadiometer.
    • The most useful information in the evaluation of a child with short stature is the child's growth pattern (see Media file 2).

      Comparison of the growth patterns between idiopat...

      Comparison of the growth patterns between idiopathic short stature and constitutional growth delay.

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      Comparison of the growth patterns between idiopat...

      Comparison of the growth patterns between idiopathic short stature and constitutional growth delay.

    • In children younger than 3 years, track length and weight at 3-month intervals.
    • Standing height and weight can be tracked at 6-month intervals in older children.

Deterrence/Prevention

  • Growth evaluation is a useful means of detecting chronic disease in children.

Complications

  • Short stature may be the harbinger of an occult chronic disease of childhood. Normal variant short stature may be associated with a bone mineral density that is lower than in the remainder of the (taller) population. Whether this healthy subset of the population is at higher risk of osteoporosis remains unclear.

Prognosis

  • Individuals with normal variant short stature have an excellent prognosis.
  • Treatment of patients with classic growth hormone deficiency (GHD) with rhGH can be expected to yield a height consistent with genetic potential, provided that therapy is initiated at least 5 years prior to the onset of puberty. Whether cotreatment with rhGH and a gonadotropin-releasing hormone analog (eg, leuprolide) to inhibit puberty results in greater adult height in patients with classic GHD remains controversial.
  • Treatment of hypothyroidism at least 5 years before the onset of puberty is essential to attain a height consistent with the genetic potential.
  • Any chronic illness can reduce the adult height achieved if treatment of the condition is initiated late.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Patients with mosaic Ullrich-Turner syndrome grow significantly better than patients with classic Ullrich-Turner syndrome. The patient with mosaic syndrome may grow above the third percentile of the normal female population (see Media file 4), thereby escaping the clinician's notice. In particular, girls with mosaic Ullrich-Turner syndrome may not come to attention until puberty, when they can present with primary amenorrhea. Despite a near-normal growth rate during childhood, the final adult height of a patient with mosaic Turner Syndrome (TS) may be lower than the third percentile of the normal population.
  • Because girls may not have any symptoms of Ullrich-Turner syndrome, the clinician should have a high index of suspicion for this disorder in any girl with unexplained short stature, webbed neck, peripheral edema, coarctation of the aorta, delayed puberty, or any 2 of the following: nail dysplasia, high arched palate, short fourth metacarpal, or strabismus.
  • The delayed diagnosis of a brain tumor associated with failure to thrive or grow is commonly associated with litigation.
  • Delay in the diagnosis of acquired hypothyroidism can result in litigation.
 


More on Short Stature

Overview: Short Stature
Differential Diagnoses & Workup: Short Stature
Treatment & Medication: Short Stature
Follow-up: Short Stature
Multimedia: Short Stature
References
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References

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Further Reading

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Keywords

short stature, short height, familial short stature, genetic short stature, constitutional delay of growth, constitutional growth delay, growth failure, GF, growth pattern, longitudinal growth assessment, chronic short stature, undernutrition genetic disorders, Bayley-Pinneau table, Tanner-Goldstein-Whitehouse table, premature closure of the epiphysial growth plates, growth hormone deficiency, GHD, Turner syndrome, TS, Ullrich-Turner syndrome, eating disorders, malabsorption, polyuria, polydipsia, upper-to-lower segment ratio, US/LS, Hashimoto thyroiditis, pseudohypoparathyroidism, Albright hereditary osteodystrophy, ulcerative stomatitis, Crohn disease, ulcerative colitis, Down syndrome, trisomy 21, insulinlike growth factor, IGF, IGF binding protein, IGFBP, Lerí-Weill dyschondrosteosis, SHOX, treatment, diagnosis

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Contributor Information and Disclosures

Author

Robert J Ferry Jr, MD,, Chief, Division of Pediatric Endocrinology and Metabolism, Le Bonheur Children's Medical Center, University of Tennessee Health Science Center at Memphis, and St. Jude Children's Research Hospital; Brigade Surgeon, 36th Sustainment Brigade, 13th Expeditionary Sustainment Command, U.S. Army
Robert J Ferry Jr, MD, is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, Society for Pediatric Research, and Texas Pediatric Society
Disclosure: Nutropin Speakers Bureau Honoraria Speaking and teaching; Genotropin Speakers Bureau Honoraria Speaking and teaching; Eli Lilly & Co. Grant/research funds Independent contractor; MacroGenics, Inc. Grant/research funds Independent contractor; Ipsen, S.A. (formerly Tercica, Inc.) Grant/research funds Independent contractor

Medical Editor

Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Lynne Lipton Levitsky, MD, Chief, Pediatric Endocrine Unit, Massachusetts General Hospital; Associate Professor, Department of Pediatrics, Harvard University Medical School
Lynne Lipton Levitsky, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Diabetes Association, American Pediatric Society, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Pfizer Grant/research funds P.I.; Tercica Grant/research funds PI, also occasional consultant

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfizer, Inc. Honoraria Consulting

 
 
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