Short

2. Short stature
Mohammed Al Shehhi
Family medicine resident

3. Objectives
• How to approach child with short stature?
• How to differentiate between normal and
pathological cause of short stature?

4. Short stature
• Short stature is defined as a height that is 2
standard deviations (SD) or more below the
mean height for individuals of the same sex
and chronologic age in a given population or
below 3rd percentile.

5. Differential diagnosis of short stature

6. Short stature evaluation
1. History & Physical examination
2. Growth assessment
3. Growth velocity
4. Midparental height
5. Bone age

7. History & Examination

8. Growth parameters

9. Growth velocity
• Growth velocity >=5cm
• Pathological <5cm

10. Midparental height
• Boys
[Paternal height (cm) + 13 cm + maternal height
(cm)] ÷ 2
• Girls
[Paternal height (cm) – 13 cm + maternal height
(cm)] ÷ 2

11. Projected height
Midparental height +/- 10cm
Familial short stature

12. Bone age
Delayed bone age in pathological and
constitutional short stature

13. Familial short stature

14. Constitutional short stature

15. Pathological short stature

16. Investigations

17. Short stature evaluation

18. Treatment
• Recombinant growth hormone
• Oxandrolone (anabolic streoid)
• Insulinlike growth factor
• Aromatase inhibitors

19. Referral

20. Conclusion
• History and physical examination findings
should guide further evaluation for pathologic
causes of short stature.
• Familial short stature and constitutional delay
of growth and puberty are normal variants of
growth.

21. References
• Evaluation of Short and Tall Stature in
Children. www.aafp.org/afp .
• Diagnostic approach to children and adolescents
with short stature. www.uptodate.com

22. Thank you..