Short Stature

Aka: Short Stature, Delayed Linear Growth, Delayed Growth

1. See Also
   1. Failure to Thrive
2. Evaluation: Algorithm
   1. Determine if growth is truly delayed
      1. See Calculation of Growth Delay
   2. Determine when growth delay began (in-utero, perinatal or childhood)
      1. See Growth Delay Onset Determination
3. Exam: General
   1. Weight Measurement in Children
   2. Height Measurement in Children
   3. Body Mass Index
   4. Weight for Height Age
   5. See Dysmorphic features in Congenital Dysorders
4. Exam: Findings suggestive of collagen bone disease
   1. Examples
      1. Osteochondrodysplasia
      2. Metaphyseal dysostosis
   2. Extremely Short
      1. Disproportionate shortness ("Dwarf")
         1. Arms and legs short compared with trunk
      2. Proportionate shortness
         1. "China Doll" Shortness
   3. Abnormal measurements
      1. Linear Growth Velocity
      2. Tanner Staging (See Tanner Staging)
      3. Arm Span
      4. Upper to Lower Segment Ratio
5. Exam: Term Newborn
   1. Micropenis (size <2.8 cm stretched)
      1. Assess for Luteinizing hormone deficiency
      2. Associated with panhypopituitarism
   2. Congenital Nystagmus
      1. Assess for septo-optic dysplasia
      2. Associated with Growth Hormone deficiency
6. Diagnostics
   1. Bone Age Films
   2. Formal dental exam for dental age
7. Labs: Routine
   1. Urinalysis
   2. Complete Blood Count
   3. Erythrocyte Sedimentation Rate (ESR)
   4. Chemistry panel (Chem8)
   5. Liver Function Test
   6. Serum Iron and Ferritin
8. Differential Diagnosis (with specific related evaluation)
   1. Normal tests, evaluation and Bone Age Films
      1. Familial Short Stature
   2. Normal tests and evaluation with a minimally delayed Bone Age Film
      1. Constitutional Short Stature
   3. Abnormal tests or evaluation with a normal Bone Age Film (requires further evaluation)
      1. Iron Deficiency Anemia
      2. Inflammatory conditions
   4. Dysmorphic features present - Refer to geneticist and endocrinologist
      1. Down Syndrome
      2. Noonan Syndrome
      3. Prader-Willi Syndrome
      4. Russell-Silver Syndrome
      5. Skeletal Dysplasia
      6. Turner Syndrome
      7. Fetal Alcohol Syndrome
   5. Abnormal labs or evaluation with delayed bone age imaging
      1. Gluten-sensitive Enteropathy
         1. Tissue transglutaminase antibodies
         2. Antiendomysial Antibody titers
      2. Cystic Fibrosis (typically age <2 at diagnosis)
         1. Sweat Chloride testing
      3. Cushing Disease
         1. 24 hour Urine Cortisol
      4. Growth Hormone deficiency
         1. IGF-1
         2. IGF-binding protein #3
      5. Hypothyroidism
         1. Thyroid Stimulating Hormone (TSH)
         2. Free T4
      6. Vitamin D Deficiency (Rickets)
         1. 25-hydroxyvitamin D
         2. 1,25-dihydroxyvitamin D
         3. Parathyroid Hormone
9. References
   1. Nwosu (2008) Am Fam Physician 78(5): 597-4