Copyright © 2007 Elsevier Ltd All rights reserved.
Review
Idiopathic short stature: Definition, epidemiology, and diagnostic evaluation
Received 21 November 2007;
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Abstract
Idiopathic short stature is a condition in which the height of the individual is more than 2 SD below the corresponding mean height for a given age, sex and population, in whom no identifiable disorder is present. It can be subcategorized into familial and non-familial ISS, and according to pubertal delay. It should be differentiated from dysmorphic syndromes, skeletal dysplasias, short stature secondary to a small birth size (small for gestational age, SGA), and systemic and endocrine diseases. ISS is the diagnostic group that remains after excluding known conditions in short children.
Keywords: Growth; Short stature; Idiopathic short stature; Diagnosis; Growth hormone deficiency
Article Outline
- 1. Introduction
- 2. Definition and epidemiology
- 2.1. How should ISS be defined?
- 2.2. Should ISS be sub-categorized? And if so, how?
- 2.2.1. Auxology
- 2.2.2. Biochemical
- 2.2.3. Radiological
- 2.3. How does sub-categorization help management?
- 2.4. Which disorders should be excluded in the process of ISS diagnosis?
- 2.4.1. Dysmorphic syndromes
- 2.4.2. Skeletal dysplasias
- 2.4.3. Short stature secondary to SGA
- 2.4.4. Systemic diseases
- 2.4.5. Endocrine diseases
- 2.4.5.1. Hypothyroidism and Cushing’s syndrome
- 2.4.5.2. GH deficiency
- 2.4.5.3.GH resistance
- 2.5. What is the place for ethno-specific growth curves in the evaluation of ISS?
- 2.6. What is the frequency of ISS amongst short children?
- 2.7. What is the natural history of ISS?
- 2.8. What are the cross-cultural implications of a diagnosis of ISS for the children and the parents?
- 2.9. What are the criteria to initiate investigation in short patients?
- 3. Diagnostic evaluation of short stature
- 3.1. The diagnostic process
- 3.1.1. What are the elements in the history that should be collected on these patients?
- 3.1.2. What are the elements in the physical exam that should be documented?
- 3.1.3. What are the screening laboratory tests that should be performed on these patients?
- 3.1.4. What is the value of a bone age X-ray?
- 3.1.5. What are the indications for a skeletal survey?
- 3.2. In which of these patients should growth hormone secretion be assessed?
- 3.3. How should growth hormone secretion be assessed?
- 3.3.1. Stimulation tests
- 3.3.2. Priming
- 3.3.3. Cut-offs
- 3.3.4. Secretion profiles
- 3.3.5. GH-dependent growth factors
- 3.4. When should a pituitary MR scan be performed?
- 3.5. How should the pediatric endocrinologist evaluate GH sensitivity?
- 3.6. GH and IGF assay performance and normative data
- 3.7. What are the indications for genetic testing (and which tests)?
- 4. Conclusion
- Acknowledgements
- References







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