Definition of short stature】 Short stature refers to individuals of the same race, sex and age whose height is lower than the average height of the normal population by 2 standard deviations (-2SD) or lower than the 3rd percentile (-1.88SD) in a similar living environment. For proper diagnosis, appropriate clinical observation and laboratory tests must be performed on children with growth retardation.
The common features of these diseases are slow growth, annual height value is lower than the standard of the same age, and they will be half a head shorter than the children in the same class in kindergarten (5-10 cm), and the height gap with the same age will gradually increase as the age increases.
2.Non-disease dwarfism: Low birth weight children, premature children, children less than gestational age, familial dwarfism, and somatic growth retardation are non-disease dwarfism, whose common feature is that they are often short at birth, but their growth rate is normal and their height is always lower than normal.
3. Precocious puberty: we call it precocious puberty when sexual signs appear before the age of 8 for girls and 9 for boys, or when menstruation appears before the age of 10 for girls. Such children have accelerated skeletal growth and early epiphyseal closure, and although they are temporarily taller than other children of the same age, they tend to be shorter than normal in adulthood.
Diagnosis] A comprehensive examination must be conducted on children with short stature to clarify the cause for treatment.
A. Medical history Careful inquiries should be made about: the pregnancy of the child’s mother; the birth history of the child; the birth length and weight; the growth history; the parents’ youth development and the short stature in the family, etc.
In addition to the routine physical examination, the following items should be measured and recorded correctly: ① measurement of current height and weight; ② target height measured from the parents’ height; ③ sexual development stage.
The following items should be measured and recorded correctly: ① current height and weight; ② target height according to parents’ height; ③ sexual developmental stage.
Bone Age (BA) is a good indicator to assess the development of an organism. Bone age is the maturity of bone at each age and is determined by observing the growth and development of each ossification center on orthogonal X-ray of the left wrist, palm and finger bones. The most used methods at home and abroad are the G-P method (Greulich & Pyle) and the TW3 method (Tanner-Whitehouse), and the G-P method is mostly used in our clinic. Under normal circumstances, the difference between bone age and actual age should be between ±1 year, and being too far behind or too far ahead is considered abnormal.
3.Special examination (1) Indications for special examination ①those whose height is lower than the normal reference value minus 2SD (or lower than the 3rd percentile); ②those whose bone age is lower than the actual age by more than 2 years; ③those whose height growth rate is below the 25th percentile (according to bone age), i.e. <7CM/rh for children <2 years old; ④those who have clinical symptoms of endocrine disorder or dysmorphic syndrome; ⑤those who need to have other reasons for Pituitary function test. (2) Growth hormone stimulation test The physiological screening tests such as exercise and sleep, which were used in the past, are rarely used nowadays, and most of them directly use drug stimulation test. (3) Measurement of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) The serum concentration of both increases with age and development, and is related to nutrition and other factors, so each laboratory should establish its own reference data. (4) IGF-1 production test In children with suspected GH resistance (Laron syndrome), this test can be used to detect GH receptor function.