II. Differential Diagnosis
- Normal variants
- Constitutional Tall Stature
- Familial Tall Stature
- Endocrine disorders
- Growth Hormone excess (GH Secreting tumors, pituitary Gigantism, or Cerebral Gigantism or Soto Syndrome)
- Obesity
- Precocious Puberty
- Congenital Adrenal Hyperplasia (Untreated, pubertal)
- Hyperthyroidism (Thyrotoxicosis)
-
Genetic disorders - disproportionate overgrowth
- Marfan Syndrome
- Homocystinuria
- Beckwith-Wiedemann Syndrome
- Klinefelter Syndrome
-
Genetic disorders - proportionate overgrowth
- Fragile X Syndrome
- Cerebral Gigantism (Sotos Syndrome)
- Weaver Syndrome
III. Evaluation
IV. Labs: Specific
- Insulinlike Growth Factor 1 (IGF-1) - consult local endocrinology
- Thyroid Stimulating Hormone (Hyperthyroidism)
- Amino Acid screen (Homocystinuria)
- Chromosome Karyotype (Klinefelter Syndrome, XXY in males)
- Glucose (Beckwith-Wiedemann)
- FSH, LH, Serum Testosterone, 17-Hydroxyprogesterone (Precocious Puberty, Congenital Adrenal Hyperplasia)
V. Imaging
- Bone Age XRay
VI. Evaluation
- Indications for Tall Stature evaluation
- Height > 2 SD above mean for age
- Projected height >2 SD above Midparental Height
- Normal exam, Bone Age and no dysmorphic features
- Constitutional Tall Stature
- Familial Tall Stature (consistent with Midparental Height)
- Normal exam without dysmorphic features, but with accelerated Bone Age, and recent growth spurt
- Obesity
- Precocious Puberty (early sexual characteristics)
- Growth Hormone excess
- Hyperthyroidism
- Dysmorphic features and proportionate growth
- Fragile X Syndrome
- Cerebral Gigantism (Sotos Syndrome)
- Weaver Syndrome
- Dysmorphic features and dysproportionate growth
- Marfan Syndrome
- Homocystinuria
- Beckwith-Wiedemann Syndrome
- Klinefelter Syndrome
VII. Management
- Idiopathic Tall Stature
- No intervention needed
- Older methods have fallen out of favor
- High dose sex Hormones promote Growth Plate closure, but have significant adverse effects
- Growth Plate destruction (via surgery) is controversial
- Pituitary Gigantism
- Growth Hormone suppression (e.g. Octreotide, pegvisomant)
VIII. References
- Alpert (1998) Pediatr Rev 19(9):303-5 [PubMed]
- Barstow (2015) Am Fam Physician 92(1): 43-50 [PubMed]
- Cuttler (1987) Pediatrician 14(3):109-20 [PubMed]
- Leung (1995) Can Fam Physician 41:457-68 [PubMed]
- Nwosu (2008) Am Fam Physician 78(5): 597-4 [PubMed]
- Rosenfield (1996) Endocrinol Metab Clin North Am 25:743 [PubMed]
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Related Studies
Concepts | Finding (T033) |
SnomedCT | 248328003 |
Dutch | grote gestalte, gestalte; groot, groot; gestalte |
French | Grande taille |
German | Statur grossgeachsen |
Italian | Statura alta |
Portuguese | Estatura alta |
Spanish | Estatura alta, alta estatura (hallazgo), alta estatura, talla alta |
Japanese | 高身長, コウシンチョウ |
Czech | Vysoký vzrůst |
English | tall stature, stature tall, Stature tall, Large stature, Tall stature, Tall stature (finding), stature; tall, tall; stature |
Hungarian | Termet magas |