April Week 3: Short Stature
Articles:
1. A General Pediatric Approach to Evaluating a Short Child. Rose et al. Peds in Review. 2005.
2. Short Stature in Childhood — Challenges and Choices. Allen and Cuttler. NEJM. 2013.
Cases:
1. It is a Wednesday and you are Blue Senior, which means you are happily helping out in Heme/Onc clinic. Your 11 year old male patient’s parents are relatively displeased to have to explain his entire course to you, but they do tell you that he is there for his 6 month follow-up after treatment for a tumor. His treatment course included both steroids and cranial/spinal irradiation. He is generally doing well, although his parents are concerned about his height. He is the shortest boy in his class, dad is 5’6″ and mom is 5’2.”
– What parameters are important to use in your assessment of this child’s growth?
– Given that he had spinal irradiation, is this patient’s actual height a good indicator of his growth? What would you use instead?
– How will you know whether his height is appropriate? What formula do you use?
– Dad asks you about whether the steroids that his son was on will affect his height long-term. What do you tell him?
2. You are volunteering at a clinic that serves District 12 in Panem. The residents of this district have a poor diet (consisting primarily of thin gruel, with the occasional pigeon or squirrel thrown in a couple of times per month) and your current patient is a 15 year old male who is at the 3rd percentile for height and the 2nd percentile for weight. On physical exam, he is Tanner II but otherwise has no abnormalities. He is here for his annual physical, has not been seen in over 3 years, and has no medical records available.
– What is the most likely reason for short stature in this child?
– What are some important questions to ask him and his parents that will help you evaluate his growth?
– Would you do screening tests? Which ones? When would you like to see this patient again?
3. You are in CYAS clinic on a Friday afternoon, seeing 4 year old twins Aaron and Erin for their WCC. When you review the growth curves, you notice that the children are both below the 5th percentile for height, and around the 10th percentile for weight. When you go in to see them, you meet mom, who is 5’1″ and petite. You find out the children are developmentally normal, have no significant medical history, and eat a varied and nutritious diet. Their physical examinations are normal.
Mom’s main concern at this visit is their height. She knows that both children are short, but she is mainly concerned about her son. She says that she believes if he remains short, he will be less successful in life and will have fewer opportunities, so she would like you to begin treatment with growth hormone for her son only. (All characters in this question are fictitious. Any resemblance to living persons is coincidental.)
– What are some of the pros and cons of growth hormone treatment?
– What do you tell her? How would you manage this child, and would you agree to treat him?
Cases/Questions by Dr. Krupa Playforth