Disorders of growth

Most children who have short or tall stature are healthy and are simply at the extremes of the normal range. Children settle on to a centile position by 2 or 3 years of age and after this a normal child will grow fast enough to stay on the same centile until puberty. During puberty, sex steroids stimulate growth directly and increase growth hormone (GH) secretion, leading to the pubertal growth spurt. Most short children are growing in a normal pattern. Any short child whose pattern of growth is abnormal (reduced growth velocity) should be investigated. Endocrine causes of reduced growth velocity include GH deficiency and hypothyroidism; in Turner's syndrome and skeletal dysplasias GH secretion is normal but the skeletal response is abnormal. Most tall children are growing in a normal pattern and do not have any underlying pathology. It is important to exclude Marfan's and Klinefelter's syndromes, and central precocious puberty. GH-secreting adenomas are a rare cause of tall stature.