Tall Stature

Aka: Tall Stature

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II. Definitions

  1. Tall Stature
    1. Height >2 SD ABOVE the mean height for age and gender (or >97th percentile on growth curve) OR
    2. Height >2 SD (>10 cm or 3.9 in) above calculated Midparental Height

III. Differential Diagnosis

  1. Normal variants (most common causes of Tall Stature, along with Obesity)
    1. Constitutional Tall Stature (constitutional advancement of growth)
      1. Early growth at age 2-4 years with advanced Bone Age, then normal Growth Velocity and early Puberty
      2. Pubertal growth ceases earlier than expected, resulting in normal adult height
      3. Similar to Obesity related linear growth pattern
    2. Familial Tall Stature
      1. Height <2 SD (<10 cm or 3.9 in) above calculated Midparental Height
  2. Endocrine disorders
    1. Obesity (most common endocrine condition related to Tall Stature)
      1. Early growth with advanced Bone Age, then normal Growth Velocity and early Puberty
      2. Pubertal growth ceases earlier than expected, resulting in normal adult height
      3. Similar to Constitutional Tall Stature related linear growth pattern
    2. Growth Hormone excess (Acromegaly)
      1. GH Secreting tumors
      2. Pituitary Gigantism (Cerebral Gigantism or Soto Syndrome)
    3. Precocious Puberty
    4. Congenital Adrenal Hyperplasia (Untreated, pubertal)
    5. Hyperthyroidism (Thyrotoxicosis)
  3. Genetic disorders - disproportionate overgrowth
    1. Marfan Syndrome
    2. Homocystinuria
    3. Beckwith-Wiedemann Syndrome
    4. Klinefelter Syndrome
  4. Genetic disorders - proportionate overgrowth
    1. Fragile X Syndrome
    2. Cerebral Gigantism (Sotos Syndrome)
    3. Weaver Syndrome

IV. Evaluation

  1. See Dysmorphic features in Congenital Disorders
  2. Past History
    1. Birth history
    2. Developmental Milestones
    3. Family History related to growth and development
      1. Tall relatives with associated eye, cardiac, musculoskeletal or Developmental Disorders
  3. Assess parental heights
    1. See Midparental Height
    2. Height <2 SD (<10 cm or 3.9 in) above calculated Midparental Height suggests familial Tall Stature
  4. Weight Measurement in Children
  5. Height Measurement in Children
  6. Body Mass Index (BMI)
  7. Weight for Height Age
  8. Upper to Lower Segment Ratio
  9. Precocious Puberty findings (e.g. Tanner Stage)

V. Labs: Specific

  1. Insulinlike Growth Factor 1 (IGF-1) - consult local endocrinology
  2. Thyroid Stimulating Hormone (Hyperthyroidism)
  3. Amino Acid screen (Homocystinuria)
  4. Chromosome Karyotype (Klinefelter Syndrome, XXY in males)
  5. Glucose (Beckwith-Wiedemann)
  6. FSH, LH, Serum Testosterone, 17-Hydroxyprogesterone (Precocious Puberty, Congenital Adrenal Hyperplasia)

VI. Imaging

  1. Bone Age XRay

VII. Evaluation

  1. Indications for Tall Stature evaluation
    1. Height >2 SD ABOVE the mean height for age and gender (or >97th percentile on growth curve) OR
    2. Height >2 SD (>10 cm or 3.9 in) above calculated Midparental Height
  2. No dysmorphic features
    1. Advanced Bone Age
      1. Obesity
      2. Constitutional Tall Stature
      3. Precocious Puberty (early sexual characteristics)
    2. Normal Bone Age and height >2 SD ABOVE mid-parental height
      1. Growth Hormone excess
      2. Hyperthyroidism
    3. Normal Bone Age and height <2 SD ABOVE mid-parental height
      1. Familial Tall Stature (consistent with Midparental Height)
  3. Dysmorphic features
    1. Proportionate growth
      1. Fragile X Syndrome
      2. Cerebral Gigantism (Sotos Syndrome)
      3. Weaver Syndrome
    2. Dysproportionate growth
      1. Marfan Syndrome
      2. Homocystinuria
      3. Beckwith-Wiedemann Syndrome
      4. Klinefelter Syndrome

VIII. Management

  1. Idiopathic Tall Stature
    1. No intervention needed
    2. Older methods have fallen out of favor
      1. High dose sex Hormones promote Growth Plate closure, but have significant adverse effects
      2. Growth Plate destruction (via surgery) is controversial
  2. Pituitary Gigantism
    1. Growth Hormone suppression (e.g. Octreotide, pegvisomant)

IX. References

  1. Alpert (1998) Pediatr Rev 19(9):303-5 [PubMed]
  2. Barstow (2015) Am Fam Physician 92(1): 43-50 [PubMed]
  3. Caro (2025) Am Fam Physician 111(6): 532-42 [PubMed]
  4. Cuttler (1987) Pediatrician 14(3):109-20 [PubMed]
  5. Leung (1995) Can Fam Physician 41:457-68 [PubMed]
  6. Nwosu (2008) Am Fam Physician 78(5): 597-4 [PubMed]
  7. Rosenfield (1996) Endocrinol Metab Clin North Am 25:743 [PubMed]

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