David B. Allen, MD, from the University of Wisconsin School of Medicine and Public Health, in Madison, and Leona Cuttler, MD, from the Case Western Reserve School of Medicine, in Cleveland, discuss management of short stature in a case vignette featuring an 11.5-year-old boy.
The researchers note that when the child's height deficit is severe (below the first percentile for age), the growth rate is abnormally slow (less than 10th percentile for bone age), the predicted height differs significantly from the midparental height, or the body proportions are abnormal, a thorough evaluation of short stature is warranted. The growth rate can be increased with human growth hormone treatment, which also results in modest increases in adult height. The safety of human growth hormone treatment has been demonstrated but it is expensive and uncertainty remains regarding the long-term risk:benefit ratio for essentially healthy children. Given the lack of evidence linking short stature with psychological harm or showing a long-term benefit of growth-enhancing therapy, for most children with short stature, observation and reassurance are reasonable. An effective and relatively inexpensive option for growth acceleration is low-dose oxandrolone, but it has not been shown to increase adult height.
"Management options for short stature are widely disparate, with important implications with respect to cost and complexity of care," the authors write.
One author disclosed financial ties to Novo Nordisk.