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Growth Hormone & IGF Research
Volume 18, Issue 2, April 2008, Pages 89-110
 
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doi:10.1016/j.ghir.2007.11.004    How to Cite or Link Using DOI (Opens New Window)
Copyright © 2007 Elsevier Ltd All rights reserved.

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Idiopathic short stature: Definition, epidemiology, and diagnostic evaluation

J.M. Wita, Corresponding Author Contact Information, E-mail The Corresponding Author, P.E. Claytonb, A.D. Rogolc, M.O. Savaged, P.H. Saengere and P. Cohenf

aDepartment of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands bDepartment of Endocrinology, Royal Manchester Children’s Hospital, Manchester, United Kingdom cDepartment of Pediatrics, University of Virginia, Charlottesville, VA 22911-8441, USA dCentre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom eDepartment of Pediatrics, Albert Einstein College of Medicine, Bronx New York 10467, USA fDepartment of Pediatric Endocrinology, Mattel Children’s Hospital at UCLA, Los Angeles, CA 90095, USA

Received 21 November 2007; 
accepted 21 November 2007. 
Available online 7 January 2008.

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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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