What is Short Stature?
Being short in height, or what is called “short stature,” is defined as a condition where a person’s height is considerably lower than the average for their age, sex, and population group. Some people might have this because of hormone imbalances, genetic issues, or certain growth disorders. Doctors can diagnose short stature by doing various tests like checking hormone levels, assessing bone age, and other things. The key goal in treating short stature is to address the root cause and manage any related emotional and social stress that may come along with it.
While we might just think of it as “height,” in science, it’s called “height vertex.” It is measured from the ground to the top of the head when the head is held straight. There are many ways to measure this, like using a measuring tape, stadiometer (a tall stick with a sliding horizontal rod used in medical offices), and others. If someone’s height is significantly lower than other people their age, sex, and population group, they are usually considered as having short stature. When we talk about it in medicine, we sometimes refer to it as “dwarfism.”
There are two types of short stature. In proportionate short stature (PSS), a person’s arms, legs, and body are all short, but in proportion to each other. But in disproportionate short stature (DSS), a person’s sitting and standing height significantly differ, meaning the length of their legs compared to their upper body is not in proportion. There are many other ways to categorize short stature, depending on the cause, including idiopathic short stature (where no cause can be found), familial short stature (where it tends to run in families), and constitutional short stature and constitutional delay of growth in adolescence (where children grow slower than their peers but eventually catch up).
What Causes Short Stature?
Your height, or stature, is decided by both your genes and your environment. Short stature can happen for four main reasons.
Firstly, genetics: your height is often similar to that of your parents. If your parents or anyone in your family is short, then there’s a good chance you will be too, as long as there’s no underlying medical reason. This is known as familial short stature (FSS). People with FSS have normal growth rates and don’t have delays in the developing of their bones.
Secondly, constitutional growth delay: this relates to the speed at which you grow. Some kids simply grow slower than others and might seem small for their age, or enter puberty later. Yet, they usually catch up once they’ve finished growing, meaning they might be short during childhood but reach a normal height in adulthood. Factors like malnutrition during early childhood or even while still in the womb can affect your growth speed. Additionally, if you’re genetically predisposed to short stature, these factors might worsen the situation.
Thirdly, early puberty: if a child enters puberty early, they may not reach their full growth potential. Various factors influence early puberty, including the earlier development of reproductive system, abnormalities in the brain and nervous system, as well as genetic circumstances.
Lastly, there are various medical reasons for short stature. Short stature can result from diseases and conditions, notably, hormone deficiencies. For instance, growth hormone deficiency (GHD) can cause short stature. Growth hormones, regulated by the brain, stimulate the production of another hormone called insulin-like growth factor-1 (IGF-1), which promotes bone growth.
Other medical causes for short stature can be genetic disorders like Down syndrome, Turner syndrome, and others. These disorders can impact growth and often come along with hormonal imbalances, which can slow growth and cause irregular menstrual cycles, among other issues. Bone diseases can also contribute to short stature by affecting bone growth.
Chronic health conditions such as cystic fibrosis, juvenile idiopathic arthritis (JIA), anemia, chronic kidney problems, and inflammatory bowel disorder can also impact overall growth. And finally, exposure to environmental pollutants such as lead, cadmium, and others, has also been linked to reduced height.
Risk Factors and Frequency for Short Stature
Your height is affected by a mix of genetics and the climate you live in. For example, people living in very cold climates tend to be shorter, while those in hot climates are usually taller. These observations were made by scientists Allen and Bergmann in the 19th century. In addition, people in Equatorial Africa, near the equator, tend to have longer limbs than those in cooler climates. This means that you might be average height for people in your area but seem short compared to people in other parts of the world. That’s why your height is usually compared to the average height of people in your specific population.
According to general statistics, about 97.5% of people have normal or above average height, while about 2.5% are considered short. However, the climate in your area can affect these numbers.
- In Saudi Arabia, studies have shown that 11.3% of boys and 10.5% of girls are considered short. The rates are lower for teenagers, with 1.8% of boys and 1.2% of girls being short.
- In Jordan, about 4.9% of the population is short.
- In Spain, only 1% of the children studied were short, which was due to lack of proper nutrition.
- In Japan, a huge study found that only 0.06% of children born small met the criteria for growth hormone treatment, implying that their short height was not a cause for concern.
- In the United States, out of a large sample studied, only 555 children were considered short.
- In a study from South India, about 2.86% of school kids were found to be short. The most common causes were genetics and delayed growth, while a smaller number had medical issues like hypothyroidism or growth hormone deficiency, or were affected by poor nutrition.
There are also differences between boys and girls when it comes to height. In South China, more boys are likely to be admitted to the hospital for height-related concerns, possibly due to societal expectations placed on boys. However, in Argentina, a study found that there were more short girls (16.4%) than short boys (8.4%). The short stature in girls was linked to their age, weight and obesity.
Last but not least, anyone whose bones have not yet stopped growing (a process known as skeletal maturation) can experience changes in height.
Signs and Symptoms of Short Stature
Determining a diagnosis involves several in-depth procedures, such as conversations with the patient, physical measurements, analyzing genetic background, and biochemical tests. The process typically involves the following steps:
- Anthropometric measurements: The individual’s height, weight, torso height, and length of limbs are measured. These measurements are compared to what’s typical for their age, gender, and population.
- Medical history: The health history of the individual is evaluated. This includes everything from their time in the womb to their birth, when they reached certain childhood and teenage milestones, when they went through puberty, any past illnesses, and their nutritional diet.
- Family history: The medical history of the individual’s family is looked at. This could include checking if other family members have had similar height issues.
In addition to these basic procedures, the individual’s psychological state may be evaluated through a series of questions. The questions aim to assess changes in behavior, social relationships, and family interactions.
Testing for Short Stature
If a child is suspected to have short stature, which means they are significantly shorter than other children of the same age and sex, several tests may be performed to understand the reason behind it.
These tests include medical procedures that review eating habits and the presence of certain hormones and substances in the blood. For example, assessments of growth hormones may be conducted – these are chemicals in the body that help control our growth. Levels of something called insulin-like growth factor-1 in the blood may also be checked, this is a hormone that supports the action of growth hormone. Furthermore, a complete blood count is usually performed to check for any blood disorders.
In addition to these tests, x-rays might be used to estimate the child’s bone age, which is a way to see how much the child’s bones have developed compared to their actual age. The most common method for assessing bone age is called the Greulich-Pyle method and it usually involves examining an x-ray of the child’s left hand.
Besides these specific tests, doctors will also consider other symptoms the child might be experiencing. They would look at signs related to genetic and nutritional issues, as well as symptoms of other potential diseases. These examinations can be really helpful in discovering the root cause behind the child’s short stature.
Treatment Options for Short Stature
The main goal in treating short stature is to address the root cause. If it’s due to a hormone deficiency, hormone treatments should be used. If it’s caused by a bone disease, the focus should be on treating that disease.
Today, there are several hormone treatments available that can treat hormone-related conditions causing short stature. These treatments should be started as soon as possible to treat the root cause, prevent the development of short stature, and minimize its psychological effects. Some of these treatments include, but aren’t limited to, gonadotropin-releasing hormone analogs (GnRHa), which regulates the release of other hormones, aromatase inhibitors, which reduce the production of certain hormones, recombinant human insulin-like growth factor- 1 (RhIGF-1), which affects growth and development, as well as recombinant human growth hormone (rhGH) and low-dose androgen therapy.
GnRHa are used in cases of early or precocious puberty. They suppress the release of certain hormones, allowing for more time for puberty development. This could lead to delayed bone maturation and slower closing of growth plates, which could potentially affect growth rate. Low-dose androgen therapy, with medications like oxandrolone, has been shown to increase the growth potential in males entering puberty. In animal studies, it has also been found to effectively prevent development of osteopenia (low bone density) and short stature.
In animal studies, maternal treatment with metformin, a medication to lower blood glucose levels, appears to improve fetal growth. Metformin increases insulin sensitivity in the fetus, leading to higher glucose uptake by the tissue and better overall growth.
Recombinant human insulin-like growth factor- 1 (RhIGF-1) has been used in children to treat deficiencies in insulin-like growth factor-1 (IGF-1), a hormone that influences growth. Additionally, aromatase inhibitors, which block the action of an enzyme that converts specific hormones, thereby delaying puberty, have also been shown to be effective in children. These inhibitors could potentially delay bone maturation and increase height.
Recombinant C-natriuretic peptide (CNP), a hormone that regulates blood pressure, has been found to increase the growth rate over a period of up to 42 months in the treatment of achondroplasia, a form of short-limbed dwarfism.
Besides treating the underlying cause, individuals suffering from emotional distress due to their short stature should also receive mental health counseling to help them manage their feelings and develop coping strategies.
What else can Short Stature be?
There are several conditions that could contribute to slow or stunted growth in children. These conditions can be categorized into:
- Endocrine disorders such as growth hormone deficiency, issues with insulin-like growth factor-1, congenital hypothyroidism, and stunted growth due to structural brain abnormalities or pituitary lesions.
- Genetic disorders like Down Syndrome, Turner Syndrome, 3M Syndrome, Noonan Syndrome, Prader-Willi Syndrome, Aarskog Syndrome, and Silver-Russell Syndrome.
- Bone diseases including dwarfism, achondroplasia (short-limbed dwarfism), diastrophic dysplasia (short-limbed dwarfism), spondylo-epiphyseal dysplasia (short-trunk dwarfism), and rickets.
- Chronic disorders such as cystic fibrosis, Crohn’s disease, juvenile idiopathic arthritis, anemia, chronic kidney insufficiency, inflammatory bowel disorder, and chronic malnutrition.
- Other issues like psychological distress, pituitary microadenomas, intrauterine growth deficiency, and 3M syndrome.
It is crucial for healthcare professionals to consider these factors when faced with a child with slow or stunted growth to diagnose and treat the issue accurately.
What to expect with Short Stature
Identifying and treating conditions that can be prevented early on can significantly improve the patient’s health and help them grow at the same rate as their peers. For example, Lionel Messi, considered one of the best football players, reportedly underwent treatment for a lack of growth hormones and had a successful outcome.
Prognosis, or the expected outcome, for short height in individuals who have finished growing is generally not good. However, the stress and mental strain that this causes can be controlled through counselling, indicating that help is available to deal with these challenges.
Possible Complications When Diagnosed with Short Stature
Short stature or being shorter than average can cause various complications. In women, it may hinder childbearing and childbirth, adding more stress for those already distressed. Additionally, short stature might limit the growth of internal organs, which could lead to various diseases and conditions.
Effects of Short Stature on Mental Health:
- Many researchers suggest that a person’s height can significantly impact their personality.
- Height often plays a significant factor in choosing a life partner, with taller individuals generally being preferred.
- Shorter individuals can often experience bullying and teasing from peers, family, and colleagues, which can lead to isolation and increased risk of mental distress, especially during adolescence.
- It can also cause problems in different life aspects like academics, family and social relationships, and the workplace.
Preventing Short Stature
Educating patients plays a crucial role in two main areas. Firstly, it helps identify and manage conditions that can cause shorter height, which can be prevented. Secondly, it’s just as essential for guiding patients and their families on how to enhance the quality of life for individuals who aren’t likely to grow taller. This kind of guidance can also prove beneficial for individuals coping with issues like bullying, feelings of loneliness, and stress related to being shorter in height.
