Abnormally Tall Height in Kids a Concern for Pediatric Endocrinologists

APRIL 12, 2016
Jeannette Y. Wick, RPh, MBA, FASCP
Atypical height is a common reason for parents to bring children to pediatric endocrinologists.

While a child who is taller than his peers may be more socially accepted than children who are short, the child’s abnormal height can worry parents and prompt them to contact a pediatric endocrinologist.
 
The journal Hormone Research in Pediatrics has published an article ahead-of-print that specifically addressed the questions pediatric endocrinologists should ask when assessing patients with tall stature.

1. Does the child have tall stature? Assessment relies on using a good definition – tall stature is height greater than two standard deviations from normal. The authors listed a host of factors to consider, including the child’s ethnicity.
 
2. Does the child present with evidence of a syndrome? The authors list a number of questions that providers should attempt to answer while collecting background information. For example, behavioral and developmental issues are linked to a number of syndromes. Marfan and Klinefelter are 2 of the most familiar syndromes, but numerous others can cause tall stature. In addition, family history of eye, heart or musculoskeletal problems, thromboembolic events, and developmental delay may be clues about the problem's origin.
 
3. Has there been growth acceleration? Growth acceleration can indicate puberty, but may occur pursuant to other hormonal changes. If bone age is advanced, but height for bone age is within the target height range, the child may go through early puberty and develop obesity in later childhood
 
4. Are there signs of puberty? If not, growth hormone excess or hyperthyroidism may be a problem.
 
5. Is the child with his or her target height range based on the parents' height? Once this last question is answered negatively, clinicians must rule out rare conditions like hypogonadotropic hypogonadism or a defect of the estrogen receptor alpha, both of which delay epiphyseal closure. In girls, 46,XY DSD is a very rare cause.
 
The authors discussed the pros and cons of growth-reducing therapy. The hormonal therapy used most often is sex steroids (at high doses) to hasten the growth plate’s maturation. An effective treatment is ethinyl estradiol, a high-dose estrogen.
 
The authors do not recommend treating females due to two risks: ovarian failure and decreased fertility.


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