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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayesha Javid, MBBS[2]

Synonyms and Keywords:

Overview

Short stature is characterized as a condition in which the height of the person in the 3rd percentile is the average height of the age , sex, and population group. According to Ranke (1996), “Short stature is defined as a condition in which the height of an individual is two standard deviations (SD) below the corresponding mean height of a given age, sex and population group.” [1] [2]

Historical Perspective

  • In 1967 by Pierre Maroteaux was the first man to ever mention dwarfism.

Classification

There are two types of short stature,

Proportionate short stature (PSS)

Proportionate short stature (PSS) is when the person is small, but limbs and trunk height are in proportions. [5]

Disproportionate short stature (DSS)

Whereas in disproportionate short stature (DSS), the normal proportion of limbs and trunk height is absent, and the individual shows a great difference in their sitting and standing height. [5]

Pathophysiology

Causes

Physiological causes of short stature

Familial short stature

Constitutional delay of growth and puberty

  • In addition children also have delayed pubertal maturation. This leads to a marked height discrepancy during the early teenage years compared with their peers but is followed by catch-up growth when they do enter puberty. The hallmark of CDGP is delayed skeletal age.[7]

Idiopathic short stature

Small for gestational age infants with catch-up growth

  • About 10 percent of SGA infants, particularly those born with more severe SGA, do not experience catch-up growth. This group of SGAinfants can be considered to have a pathologic pattern of growth. [9]

Pathologic causes of short stature

Systemic disorders with secondary effects on growth

Malnutrition
  • Malnutrition can lead to short stature with a delayed pattern of growth. The hallmark is low weight-for-height.
  • Malnutrition can be due to inadequate food supply, or it may be due to an underlying condition which affects food intake or absorption or increases energy requirement of the body. [10] [11]
Glucocorticoid therapy
Gastrointestinal disease
Rheumatologic disease
Chronic kidney disease
Cancer
Pulmonary disease
Cardiac disease
  • The major causes include, anorexia and increased basal energy requirements. [20]
Immunologic disease
  • Growth failure is associated with immunologic deficiencies such as common variable immunodeficiency or severe combined immunodeficiency syndrome, and infections such as HIV.[21]
Metabolic diseases

Metabolic disorders can lead to growth failure in children and adolescents.

Genetic Causes

Several genetic disorders have prominent effects on growth.

Endocrine Causes

Psychosocial short stature

It is a growth disorder that is observed between the ages of 2 and 15, caused by extreme emotional deprivation or stress which causes decrease in growth hormone (GH) and somatomedin secretion, resulting in very short stature. Patient's weight is inappropriate for the height with immature skeletal age. [30]

Differential Diagnosis

Epidemiology and Demographics

In the United States, 2.5% of the population is short. [5] A study conducted on the school children age 4-16 years in the South Indian Population shows the overall prevalence of short stature was 2.86%.[32]

Gender

  • Short stature is equally prevalent among both males and females, but studies show that boys were admitted more than the girls. This could be due to the reason that males are more likely to be brought to medical attention because of the prevalence of social expectations and pressures as compared to the females.
  • On the other hand, in Rosario, Argentina, the higher prevalence was found in females (16.4%) than males (8.4%) (p<0.001).[21] The short stature in females was related to age, weight, and abdominal obesity.

Age

  • Different ethnic groups have different average statures, which are essential to take into consideration while comparing mean parameters.
  • Any individual who has not attained the union of epiphyseal plates, can get affected.

Race

Risk Factors

Diagnosis

Diagnostic Criteria

  • The diagnostic criteria of short stature is when the height is 2 or more standard deviations below the mean for age and gender within a population (below the 2.5th percentile).[34]

Symptoms

  • Symptoms of the short stature depend on the underlying cause.

Physical Examination

Laboratory Findings

The laboratory studies used to assess the major causes of short stature include,

Electrocardiogram

X-ray

Ultrasound

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

Other Diagnostic Studies

  • [Disease name] may also be diagnosed using [diagnostic study name].
  • Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

Surgery

Prevention

References

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