Assessing tall stature

Abstract

Abstract Children and adults are considered ‘tall’ when their height is above 98th centile for age i.e. 2 standard deviations (SD) above the mean. Tall stature is familial in most cases. In assessing children with tall stature the mid-parental height centile should always be calculated and this article gives advice on how to proceed with investigation and management for children who are unexpectedly tall. Other common causes of tall stature are obesity or early normal puberty. Precocious puberty, hyperthyroidism and GH excess are less common but these will also cause rapid height velocity at any age and precocious puberty should be excluded in every child presenting with tall stature. Where height centile exceeds mid-parental centile prediction it is helpful to look for genetic syndromes, metabolic conditions and sex chromosome abnormalities. Constitutional tall stature i.e. physiologically normal advanced growth and development is a diagnosis of exclusion and treatment is rarely required. Treatment options include early and accelerated induction of pubertal development with a physiological sex hormone regimen, or epiphysiodesis, but need to be considered before puberty onset. High dose sex steroids are no longer indicated.