Consensus statement on the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology Workshop.
OBJECTIVE
Our objective was to summarize important advances in the management of children with idiopathic short stature (ISS).


METHODS
Participants were 32 invited leaders in the field.


METHODS
Evidence was obtained by extensive literature review and from clinical experience.


METHODS
Participants reviewed discussion summaries, voted, and reached a majority decision on each document section.


CONCLUSIONS
ISS is defined auxologically by a height below -2 sd score (SDS) without findings of disease as evident by a complete evaluation by a pediatric endocrinologist including stimulated GH levels. Magnetic resonance imaging is not necessary in patients with ISS. ISS may be a risk factor for psychosocial problems, but true psychopathology is rare. In the United States and seven other countries, the regulatory authorities approved GH treatment (at doses up to 53 microg/kg.d) for children shorter than -2.25 SDS, whereas in other countries, lower cutoffs are proposed. Aromatase inhibition increases predicted adult height in males with ISS, but adult-height data are not available. Psychological counseling is worthwhile to consider instead of or as an adjunct to hormone treatment. The predicted height may be inaccurate and is not an absolute criterion for GH treatment decisions. The shorter the child, the more consideration should be given to GH. Successful first-year response to GH treatment includes an increase in height SDS of more than 0.3-0.5. The mean increase in adult height in children with ISS attributable to GH therapy (average duration of 4-7 yr) is 3.5-7.5 cm. Responses are highly variable. IGF-I levels may be helpful in assessing compliance and GH sensitivity; levels that are consistently elevated (>2.5 SDS) should prompt consideration of GH dose reduction. GH therapy for children with ISS has a similar safety profile to other GH indications.
Cohen
P
P
Department of Endocrinology, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue MDCC 22-315, Los Angeles, California 90095-1752, USA. hassy@mednet.ucla.edu
Rogol
A D
AD
Deal
C L
CL
Saenger
P
P
Reiter
E O
EO
Ross
J L
JL
Chernausek
S D
SD
Savage
M O
MO
Wit
J M
JM
D000328:Adult; D001827:Body Height; D001835:Body Weight; D002648:Child; D004704:Endocrinology / Q000379:methods; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006130:Growth Disorders / Q000145:classification / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000172:deficiency; D008297:Male; D008403:Mass Screening; D012016:Reference Values
D007987:Gonadotropin-Releasing Hormone; D007334:Insulin-Like Growth Factor I