Pediatría Atención Primaria
versión impresa ISSN 1139-7632
CENAL GONZALEZ-FIERRO, M.J.. Dilemas in the diagnosis and treatment of short stature. Rev Pediatr Aten Primaria [online]. 2009, vol.11, suppl.16, pp.155-172. ISSN 1139-7632.
A clear separation between a normal height and a short stature is difficult to establish. High height is considered between + 2 standard deviations (SD) for age, sex and ethnic group and short stature is considered below 2 SD, which approximately corresponds to P3 of the reference growth charts. There are two groups: normal short stature in which are included children with familiar short stature, with constitutional delay in growth and development or with delayed puberty and short stature secondary to a pathologic condition. For the diagnosis is necessary to perform clinical history and physical examination, to assess the degree of maturation making identification of the bone age and the prediction of adult height, general analysis, antitransglutaminase A antibodies, thyroid hormones and growth factors (IGF-1 and IGFBP-3). When appropriate, a study of the secretion of growth hormone (normal > 10 ng/ml), urinary free cortisol, cranial magnetic resonance imaging of the hypothalamic-pituitary area (hypoplasia of the adenohypophysis with or without section of the pituitary stalk, ectopic neurohypophysis and the empty "sella turcica"), karyotype, and / or molecular genetic studies will be made. The treatment of short stature secondary to a specific pathologic condition will be that of the condition whenever that is possible. At present the indications for treatment of short stature with growth hormone approved in Spain are the growth hormone deficiency, Turner syndrome, chronic renal failure, Prader Willi syndrome, small for gestational age and alteration of the gene Shox.
Palabras clave : Growth; Short stature; Growth charts; Growth disorders/diagnosis; Growth disorders/treatment.