Delayed height growth

Specialty: Endocrine and metabolic.

• pathological short stature
• growth rate delay
• pituitary dwarfism

Why it occurs

• Isolated or multiple congenital or acquired growth hormone (GH) deficiency (craniopharyngioma or other tumors that compress the pituitary stalk)
• Severe juvenile or congenital primary hypothyroidism (thyroid hormone deficiency directly alters the development and ossification of the epiphyses of the growth cartilage)
• Endogenous or iatrogenic pediatric Cushing syndrome (elevated levels of glucocorticoids inhibit GH secretion and reduce collagen synthesis in the epiphyseal plate)
• Turner syndrome or other chromosomal alterations that affect the SHOX gene for height
• Celiac disease or inflammatory bowel disease (chronic malabsorption with nutrient deficiency and suppression of the IGF-1 axis)

Initial workup

Accurate measurement of height and calculation of growth speed in the last 6-12 months; simple x-ray of the left hand and wrist to determine bone age (comparison with the Greulich and Pyle atlas); serum levels of IGF-1 (insulin-like growth factor type 1) and its transporter protein IGFBP-3; anti-tissue transglutaminase IgA antibodies; TSH and free T4; dynamic GH provocation tests (using clonidine, arginine, or insulin hypoglycemia); and contrast-enhanced brain MRI focused on the sellar region.

Standard management

• Recombinant human somatotropin — growth hormone administered by subcutaneous injection daily at night at a dose calculated by body weight, with strict monitoring of IGF-1 levels and growth rate
• Levothyroxine sodium — specific replacement treatment if primary or secondary hypothyroidism is confirmed
• Triptorelin acetate — GnRH analog indicated if there is concomitant precocious puberty to delay the early closure of the epiphyseal plates and maximize adult height potential
• Prednisone at a physiological dose — substitution in case of concomitant ACTH deficiency, avoiding overcalculated doses so as not to slow linear growth