Disorders of growth

Most children of short or tall stature do not have any abnormality and are simply at the extreme of the normal range. Maternal nutrition and placental function are major influences on size at birth, and nutrition is the most important factor in growth in infancy. After 2-3 years of age, children grow on average fast enough to continue on their centile position (normal growth velocity). Most short children are growing at a normal velocity and do not have any underlying pathology. Children who are short and growing with an abnormal growth velocity should be investigated. Endocrine causes include growth hormone (GH) deficiency and hypothyroidism. In Turner's syndrome and the skeletal dysplasias, endocrinology is normal but the skeletal response is abnormal. GH treatment is licensed for use in GH deficiency, Turner's syndrome, Prader-Willi syndrome, short stature related to chronic renal failure and children who were small for gestational age. The response to GH varies, and the greatest increase in adult height is achieved in GH deficiency, when GH is given as replacement therapy. Most tall children do not have any underlying pathology and are tall but growing at a normal growth velocity. It is important to exclude syndromes of overgrowth such as Marfan's and Klinefelter's 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.