Disorders of growth

Most children who have short or tall stature do not have any abnormality 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 maintain themselves on the same centile until puberty. During puberty, sex steroids stimulate increased growth hormone (GH) secretion, and sex steroids and GH produce the pubertal growth spurt. Most short children are growing in a normal pattern and do not have any underlying pathology. 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 the skeletal dysplasias endocrinology is normal but the skeletal response is abnormal. Most tall children are growing at a normal growth velocity and do not have any underlying pathology. It is important to exclude syndromes of overgrowth such as Marfan and Klinefelter syndromes. The most common cause of tall stature with increased growth velocity is central precocious puberty. GH-secreting adenomas are a rare cause of tall stature.