Algorithm for the evaluation of a child with short stature*

This algorithm describes the detailed evaluation of a child with short stature. Some components of the evaluation can reasonably be performed in the primary care setting, including initial interpretation and height velocity, and initial laboratory screening for an underlying systemic disease, if suspected based on symptoms. Other components of the evaluation, including bone age interpretation and the detailed evaluation for causes of short stature, are typically performed by a pediatric endocrinologist, if available.

GDPP: gonadotropin-dependent precocious puberty (central sexual precocity); GIPP: gonadotropin-independent precocious puberty (peripheral sexual precocity); ISS: idiopathic short stature; CDGP: constitutional delay of growth and puberty; SD: standard deviation; GH: growth hormone.

* Short stature is defined as height that is 2 SD or more below the mean (Z-score ≤–2) for children of the same sex and chronologic age in a given population. This corresponds to a height that is below the 2.3^rd percentile.

¶ Decreased height velocity is indicated by a growth rate <5.5 cm/year from 2 to 4 years of age, <5 cm/year from 4 to 6 years of age, <4 cm/year from age 6 years to puberty, or crossing 2 major percentile lines on a standard height-by-age chart.

Δ Systemic diseases may present with signs and symptoms either before or after they affect height or height velocity. This is especially true for inflammatory diseases (Crohn disease, juvenile idiopathic arthritis) or any disorder that affects nutrition.

◊ Bone age determination requires expert interpretation of the hand radiograph using the Greulich and Pyle Atlas. If bone age is delayed or advanced, the height velocity percentile and projected height should be recalculated based on 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 translates to difference between bone age and chronologic age of approximately 12 months between 2 and 4 years of chronologic age, 18 months between 4 and 12 years, and 24 months after age 12.

¥ Evaluation for systemic, endocrine, or genetic disorders includes a focused history and physical examination (refer to topic review on evaluation for short stature). In addition, patients with growth failure usually should have laboratory screening, including a complete blood count, erythrocyte sedimentation rate or C-reactive protein, tissue transglutaminase, creatinine, electrolytes, bicarbonate, calcium, phosphate, alkaline phosphatase, albumin, thyroid-stimulating hormone, free thyroxine (T4) and insulin-like growth factor-1 (IGF-1), and insulin-like growth factor binding protein-3 (IGFBP-3). A karyotype should be performed in all girls with unexplained short stature and in short boys with associated genital abnormalities^[1]. Some or all of this evaluation is typically performed by a pediatric subspecialist but varies with the child's presenting symptoms and the clinical setting.

‡ CDGP is particularly likely if there is a family history of this growth pattern (eg, relatively late puberty).

Reference:

Cohen P, Rogol AD, Deal CL, et al. Consensus statement on the diagnosis and treatment of children with idiopathic short stature: A summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology Workshop. J Clin Endocrinol Metab 2008; 93:4210.

Graphic 94743 Version 7.0

خرید پکیج

Algorithm for the evaluation of a child with short stature*