Profile and Height Outcomes of Children with Short Stature in North India: An Experience from a Tertiary Care Centre

Abstract

To the Editor: The ongoing dynamicity in the populationin terms of change in nutritional status, improved edu-cation, awareness and access to health care is expectedto bring changes in the etiologies causing short stature(SS). This study aimed to evaluate the current etiolog-ical trends for SS and the effect of treatment on finalheight. Retrospective analysis of records of childrenreferred for SS from2003–2007withatleast4yearsfollowup was done in the Department of Endocrinology,Vardhman Mahavir Medical College & Safdarjung Hos-pital, New Delhi. (Fig. 1). SS was defined as height<3rd percentile and/or height velocity <5th percentilefor chronological age.Records of 139 children [68 girls; 71 boys; age of pre-sentation: 11.34±3.71 y (Range 2–21 y)] were analyzed ofwhich74(53.24%)hadreached18yage.Thisstudyhighlights the predominantly late presentation of childrenwith SS in India. Familial short stature (FSS)(36, 26 %) wasthe most common cause of SS followed by hypothyroidism(26, 19 %), growth hormone deficiency (GHD) (19, 14 %),constitutional delay in growth and puberty (CDGP) (17,12 %), genetic syndromes [Turner’s(n=7); Down’ssyndrome (n=4)] (11, 8 %), Celiac disease (8, 6 %),nutritional (8, 6 %), achondroplasia/hypochondroplasia(6, 4 %), chronic disease (2, 1 %) and idiopathic(6,4 %). FSS and CDGP together constitute normalvariant SS (NVSS) and is the most common cause ofSS in our country, constituting 9 % [3], 16 % [4]and20 % [5] of all SS children in different studies and38 % in our study. This increased proportion of childrenwith NVSS in our series may reflect the increasedawareness in the society and increased healthcare seek-ing. Being a referral centre our patient profile is likelyto be skewed and it is likely that NVSS is even morecommon in the population.There was a significant difference in the presenting heightstandard deviation score (SDS) (P=0.002), final height SDS(P<0.001) and the change in height SDS (Δ Ht SDS)(P<0.001) depending on the etiology of SS (Table 1). Maxi-mum height improvement (ΔHt SDS) was seen in treatedGHD children followed by treated hypothyroid andCDGP. Poor height outcomeofchildrenwithCeliacdiseaseinourstudymaybetheresultofdelayeddiagnosisandlackofcompliance to gluten free diet. Poor height outcomes in chil-drenwithachondroplasia/hypochondroplasia and SS due tosyndromes reflect the limited growth potential in thesechildren. Endocrine disorders should be actively lookedfor, since they comprise of a third of children with SS andshowmaximumimprovementinheightontreatment.Thoughthere has been increased healthcare seeking,it is quite late asevident from our study. Increased awareness among generalpopulation and pediatricians would help early detection oftreatable cases and better height of the population.