WIS- 7TH MARCH

SHORT STATURE
CASE # 1 (A) CASE # 1 (B)
9 years old BOY otherwise 9 years old GIRL otherwise
healthy, school going healthy, school going
Brought by mother as Brought by mother as
childrens appears shorter childrens appears shorter
than peers than peers
BOY GIRL
Ht:122 cm Ht:121cm
Wt:24 kg Wt:23 kg

Q1. Is child appropriate Q1. Is child appropriate

for age ? for age ?
Plot on centiles Plot on centiles
CASE # 1

Calculate predicted height

Mother Height :150 Mother Height :156
Father Height :162 Father Height :174

BOY?? GIRL??

163 150
 CASE # 1
Calculate mid parental Height of each

Mother Height :148 Mother Height :156

Father Height :162 Father Height :174

BOY ?? GIRL ??
161 158
CASE # 1
after thorough examination you find no abnormality,
you adviced follow up

• ON FOLLOW UP • ON FOLLOW UP

-3months 125.5 - 3months121

-6months127 - 6months122

HEIGHT VELOCITY ??
-6cm /year - 4cm /year
CASE # 1
• You adviced xray for bone age ?

1. Specific xray?  left wrist

2. All other test of systemic and endocrine illness were

unremarkable

bone age bone age (delayed)

= <
chronological age chronological age
 CASE # 1
• DIAGNOSIS?? • DIAGNOSIS??
-Familial short stature -Constitutional Delay of
Growth and Puberty
(CDGP/CDAP)
• Management ??
• Management ??
- GH therapy ? 
not needed - GH therapy ? 
- Reassurance not needed
- Follow up - Reassurance
- Follow up
Bone age Vs chronological age
What is delayed or advanced bone age ??

• Delayed or advanced bone age is defined as a bone age

that is 2 SD or more below or above the mean,
respectively.
• This is approximately 20 percent below or above the
chronological age.
• This translates to a difference between bone age and
chronological age of approximately
12 months between 2 and 4 years of chronological age,
18 months between 4 and 12 years,
24 months after age 12years
 CASE #2
7 years old female child brought by mother with
concerns of early breast enlargement

-Ht:120cm  predicted ht
predicted height (163cm)
-Wt : 25kg
-Tanner stage: III
-Parents height ?
mid parental height (154cm)
Mother : 156
Father :166
-Bone age (9 years)> chronological age
 CASE #2
Bone age should be used for calculated
predicted height

• Predicted height ?? <150cm

• Mid parental Height?? 154cm

• 2 Differential??
-Hyperthyroisdism
-Precocious puberty
Advanced bone age is occasionally seen in older
children and adolescents with short stature,
especially precocious puberty and
hyperthyroidism.

These children usually experienced accelerated

early growth but are at risk for early epiphysial
closure, resulting in short stature as an adult,
if not properly diagnosed and treated
 Case # 3
• 4years old children visiting your opd over past
6months due to maternal concerns that child
is not thriving upto mark, despite of all
nutritional counselling

-Significant history of birth weight

1.2kg/30weeks
-Hospitalized in infancy with AGE/pneumonia
 Case # 3
• Further evaluation ??

• showed endocrine and systemic workup--

normal
 Case # 3
Ht : 9293  94cm

• Predicted height?
<150cm
• Mid parental height 163
• Height velocity?
4cm/year
• Bone age? normal

Growth harmone therapy??

 Case # 3
Indications of growth harmone
therapy
• GH deficiency,
• Turner Syndrome
• Prader willi syndrome
• SHOX syndrome
• Noonan syndrome
• Chronic renal failure before transplantion
• Idiopathic short stature
• SGA short stature
 Case # 3
• Dosage:
0.18 -0.3mg/kg/wk divided in 6-7doses

• Indications for discontinuing therapy

- Tall enough(decision by patient)
- A growth rate <1inch /year
- BONE age (>14 in girls, >16 in boys)
 Case # 4

5years old
Child in OPD
for
evaluation of
short stature

-How would
you measure
height
 Case # 4
Other measurements

1 -Upper limb : lower limb

ratio
 Case # 4
2 ARM SPAN
3 Hands and
feet Together
 Case # 4

4 arms out straight

5 Thumbs on
shoulder
 6 Palms up

7 Make fist

8 back

9 Forward bend
 SHORT STATURE

SYSTEMIC
(RULE OUT)FSS/CDGP ILLNESS

DYSMORPHIC
DISPROPORTIONATE
KARYOTYPING

SKELETAL
SURVEY

HEIGHT VELOCITY
Normal reassuring
Else bone age
Case # 4