Tall stature
Referral for tall stature is much
less common than that for short stature. Socially, it is more acceptable to be
tall, particularly for boys. Nevertheless, tall stature, particularly when it
is associated with inappropriately increased growth rates, may indicate an
underlying growth disorder.
In the majority tall stature is
genetic in origin and inherited from tall par-ents. Other causes, although
rare, need to be considered:
· Familial.
· Early (normal) puberty.
· Obesity.
· Endocrine
disorders:
· precocious puberty;
· GH excess;
· pituitary adenoma;
· androgen excess;
· congenital adrenal hyperplasia;
· hyperthyroidism;
· aromatase enzyme deficiency (very
rare);
· oestrogen receptor defects (very
rare).
· Chromosomal abnormalities:
Klinefelter’s syndrome (XXY); XYY; XYYY.
· Other
syndromes: Marfan,
homocystinuria, Soto, Beckwith– Wiedemann.
A detailed history should be
obtained.
· Size at birth.
· Birth weight (head circumference).
· Feeding and weight gain.
E.g.
headaches/visual disturbance.
· Examine previous growth records if
available.
· Recent growth acceleration.
· Signs of puberty.
· Developmental delay.
· School performance.
· Tall stature.
· Early puberty.
Endocrine disease.
·Measure:
· height;
· weight;
· head circumference.
·Puberty staging (Tanner).
·Observe dysmorphic features;
goitre.
·Assess growth velocity over a
minimum 6-monthly interval.
·Measure
parents’ heights and calculate:
· MPH;
· family height target.
The following baseline screening
tests should be carried out:
·Karyotype (chromosomal
abnormalities—Klinefelter’s syndrome).
·Thyroid function tests/serum IGF-I
(and IGFBP-3).
·Sex hormone/LH and FSH levels.
·Androgen levels (DHEAS; 17-OH
progesterone).
·BA X-ray.
Where clinically indicated GH
suppression test (i.e. modified oral glucose tolerance test; GH levels normally
suppressed to low levels).
In familial tall stature,
reassurance and information about predicted final height are usually
sufficient. Early induction of puberty using low dose sex-steroid to advance
the pubertal growth spurt and to cause earlier epiphyseal closure is
occasionally considered. However, this produces variable results and there is a
theoretical risk of complications (including thromboembolic disease and
oncogenic risk).
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