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A. Definition navigator

  1. Also called normal-variant short stature, short stature of undefined cause
  2. Systemic and endocrine disorders have been ruled out
  3. Other factors compromising growth, including depression or psychosocial deprivation, excluded
  4. Idiopathic Short Stature
    1. Short stature in an otherwise healthy child
    2. Exclusion of other causes of short stature
    3. Bone age within 2 standard deviations (SD) of chronologic age
    4. Normal growth hormone (GH) repsonse on provocative testing

B. Determination of Projected Heightnavigator

  1. Midparental Height - provides estimate of genetic target height
  2. Calculation of Midparental Heights
    1. average of parents' heights
    2. Add 6.5cm (2.5 inches) for boys
    3. Subtract 6.5cm for girls
  3. Bone Age
    1. Also called skeletal maturation
    2. Comparing ossification centers of the hand with published standards
  4. Bayley-Pinneau Tables
    1. Chronologic age, weight, height, midparentlal height, bone age on tables
    2. Derived from normative data in healthy children followed serially

C. Indications (FDA) for GH Therapy in Children with Idiopathic Short Staturenavigator

  1. No diagnosis of GH deficiency
    1. Exclusion of causes of growth failure that require other therapeutic approaches
    2. Exclusion of other causes of short stature, such as skeletal dysplasias, syndromic conditions, systemic disease
  2. Height that is >2.25 SD below the mean for sex and age
    1. Height of children in this category falls below the 1.2 percentile
    2. Normal height definied as at least 63 inches (160.0cm) men, 59 inches (149.9cm) women
  3. Open Epiphyses
  4. Growth rate unlikely to attain an adult height within normal range

D. Use of Growth Hormone navigator

  1. Doses 0.25 to 0.40mg/kg body weight per week
  2. Given for ~5 years caused 5-6cm increase in height compared with controls
  3. Higher doses associated with more height gain than lower doses
  4. No definitive psychosocial benefits proven in various trials
  5. Only adverse event was increase in rate of idiopathic intracranial hypertension from 1:1000 in treated persons versus ~1 per 100,000 in general population
  6. Only recombinant growth hormone should be used

References navigator

  1. Lee MM. 2006. NEJM. 354(24):2576 abstract