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Short Stature is one of the most important problems in children.
Etiology:
The European Society for Pediatric Endocrinology (ESPE) classifies the main causes of
- Primary growth disorders, where the condition is intrinsic to the growth plate.
- Secondary growth disorders, where the growth plates change as a consequence of the condition.
- Idiopathic, where there is no identifiable cause of short stature.
Primary growth disorders
- Clinically defined genetic syndromes, such as:
- Down's syndrome
- Prader-Willi syndrome
- Silver- Russell syndrome
- Noonan's syndrome
- Turner syndrome
- Intrauterine growth restriction with failure to catch up:
- Fetomaternal factors
- Prematurity
- Placental dysfunction
- Congenital bone disorders such as:
- Achondroplasia
- Hypochondroplasia
- Osteogenesis imperfecta
Secondary growth disorders
- Endocrine:
- Hypothyroidism.
- Panhypopituitarism.
- Hypothalamic or pituitary lesions (eg, trauma or tumour).
- Laron's syndrome (growth hormone insensitivity).
- Cushing syndrome.
- Growth hormone deficiency or insufficiency.
- Precocious puberty.
- Disorders of the growth hormone insulin-like growth factor I axis.
- Metabolic:
- Mucopolysaccharidoses.
- Glycogen storage diseases.
- Diabetes mellitus (poor control).
- Chronic disease:
- Cardiovascular disease.
- Respiratory disease (eg, cystic fibrosis).
- Haemoglobinopathies.
- Renal disorders disease.
- Malignancy.
- Neurological (eg, hydrocephalus).
- Juvenile arthritis.
- Malnutrition:
- Poverty or neglect.
- Inflammatory bowel disease.
- Coeliac disease.
- Bowel obstruction.
- Enzyme deficiencies.
- Chronic bowel infection.
- Short bowel syndrome.
- Anorexia nervosa.
- Rickets.
- Psychosocial deprivation, including hyperphagic short stature syndrome.
- Medication: steroid therapy.
Although many etiologies have roles in short stature, however, malnutrition is important factor in short stature.
Malnutrition is the most common cause of growth failure and is usually related to poverty or anarchy. Nutritional deficiencies in developed countries are more often the result of self-restricted diets. Poor weight gain is often more noticeable than short stature.
Nutrition is most important factor specially before puberty.
Parents should check their children and refer to doctor continuously to assess children's stature.
Notice:
After puberty and fusion of the growth plates, doctor can not help to increase height, therefore patients should refer before this time.
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