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Short and Tall Stature

Short or tall stature is primarily a normal variation of height. It is part of the continuum of the normal Gaussian distribution curve which defines the lower and upper limit of normal as the 3rd and 97th percentile. Within this context it is very important to differentiate normal variations in height and growth from pathological conditions. Normal variations in height are familial and idiopathic short or tall stature. Normal variations in growth are diagnosed as constitutional acceleration or constitutional delay of growth and puberty and are observed on all percentiles. Patients with pathological conditions of height usually have a syndromal, skeletal or chromosomal disorders such as Russell-Silver or Marfan syndrome, achondroplasia, Ullrich-Turner or Klinefelter syndrome. Many of the disorders with short stature have intrauterine growth retardation. The (mean) final height does not necessarily follow the target height range, but reaches a height below or above the population 3rd or 97th percentile. Patients with pathological conditions of growth can have short, normal or tall stature. They have a reduced or increased growth rate caused by a wide variety of chronic organic or psychosomatic diseases. At present, treatment with growth hormone (GH) is available for patients with GH deficiency, Ullrich-Turner syndrome, chronic renal insufficiency, small for gestational age and Prader-Willi syndrome. The indication for GH treatment of idiopathic short stature is so far only approved in the USA. Adult height data indicate that patients with documented GH deficiency reach an adult height within their target height range. For all other indications a statistically significant improvement in adult height has been documented. In the long-term follow-up of these patients not only a statistically significant but also a clinically relevant improvement in adult height should be demonstrated. Depending on the results, some of the indications for GH therapy might have to be reconsidered.