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Short Stature or Stunting
Short Stature or Stunting
or Stunting
– Intrauterine
– Growth strongly influenced by intrauterine
environment
– Insulin, IGFs, and their binding proteins play
important roles in fetal growth
– GH, thyroid hormone not very important
– Infantile
– Rapid but decelerating growth during first 2 years
of life
– Infants often cross percentile lines during the first
24 months as they grow toward their genetic
potential and get further away from the excesses
or constraints of the intrauterine environment
Phases of Normal Growth
– Childhood
– Growth at a relatively constant velocity of 4.5 to 7 cm/year (1.8
to 2.8 cm in/year)
– Perhaps some slight slowing just prior to adolescence
– Pubertal
– Characterized by a growth spurt of 8 to 14 cm/year (3.2 to 5.5
in/year) because of the synergistic effects of increasing gonadal
steroid and growth hormone secretion
Growth failure and short
stature
– Short stature: height more than 2.0 SD below the mean for
age and gender; strictly statistical convention
– Growth failure: decline in rate of linear growth (cross
channels). Slowly growing children are usually short
– There are many non-endocrine and endocrine causes of
growth failure and short stature
Diagnostic approach
Thyrotrophs
TSH
Lactotrophs
Prolactin
Gonadotrophs
LH & FSH
Corticotrophs
ACTH
Hypothalamic-Pituitary GH-IGF1 Axis
Growth Hormone Secretion
GH measurement
– Height < - 3 SD
– Growth Velocity < 25 %
– Delayed bone age (< -2 SD)
– PAH substantially < mean parental Height (< -1.5 SDS)
– IGF1 and IGFBP3 < -1 SDS
– Impaired peak GH response to 2 provocation tests
– +/- MRI or genetic abnormalities
Treatment
– GH replacement therapy
– Pediatric endocrinologist