What is Idiopathic Short Stature? How is it treated in pediatric patients?

What is Idiopathic Short Stature? How is it treated in pediatric patients?

children with idiopathic short stature are simply shorter in height compared to their same-age, same-gender peers, with no underlying medical conditions discovered. It differs from growth disorders, as the cause of this short stature remains unclear. Although pediatric endocrinologists propose various explanations for this condition, many factors influencing growth and development in these children are still difficult to ascertain. While certain diagnostic methods can pinpoint some causes of poor growth in idiopathic short stature, there are children within this category for whom the underlying reasons remain elusive.

Emotional deprivation, resulting in stunted growth, is known as "Emotionally Deprivation Induced Stature Insufficiency" in certain overseas contexts. This primarily involves emotional inhibition affecting the function of the hypothalamus-pituitary system, leading to reduced growth hormone secretion from the pituitary. These children may exhibit disrupted sleep patterns, lack of security, and occasional episodes of calling out or waking up in tears, further impacting growth hormone secretion. In addition to shorter stature, they might also display delayed intellectual development, excessive thirst, overeating, solitary speech, hyperactivity, and difficulties in interpersonal relationships.

When pediatricians suspect developmental growth issues in children, they typically refer them to pediatric endocrinology specialists. These specialists conduct various assessments to diagnose and evaluate the child's growth and development. Parents should be alert to recognize familial (or genetic) idiopathic short stature, where children simply have shorter stature without any associated symptoms. In such cases, these children may experience sudden growth spurts, enter puberty at a normal age, but their eventual height will likely match their parents'. For children with both delayed physical growth and familial idiopathic short stature, it's important to ensure that no other treatable conditions are affecting their growth. As their shorter stature manifests before entering puberty, assisting them through the entirety of their pubertal development is necessary to help them reach a height comparable to their peers.

Treatment: Treatment for children with idiopathic short stature should commence around the age of 4, as by this time, the body's production of growth hormone and thyroid hormones is already established, and height growth is predominantly regulated by growth hormone. Even though growth rate is not significantly high in children over 3 years of age, if annual growth is less than 4 centimeters, it's advisable to seek consultation at a clinic specializing in short stature. Children with idiopathic short stature caused by growth hormone deficiency are best treated around the age of 4; parents must not mistake them for "late bloomers" and miss the optimal time for diagnosis and treatment. Some children, despite being short or entering puberty later, might also benefit from growth hormone therapy.

Currently, recombinant human growth hormone is commonly used to treat idiopathic short stature in children who lack sufficient endogenous growth hormone secretion. The dosage of growth hormone varies individually. Recommended dosages include daily administrations of 0.1 to 0.15 IU/kg body weight for children with growth hormone deficiency, and 0.15 to 0.2 IU/kg body weight for children with idiopathic short stature (ISS). The hormone is administered via subcutaneous injection, with treatment lasting from 3 months to 3 years, as directed by the physician. It's worth noting that growth hormone may lead to transient hyperglycemia, which generally normalizes with prolonged use or cessation. In clinical trials, approximately 1% of children with short stature experienced adverse reactions, commonly local transient responses (pain, tingling, redness, swelling) and fluid retention symptoms (peripheral edema, joint or muscle pain). These adverse effects occur early and decrease in frequency as treatment duration extends, rarely impacting daily activities. The intervention of growth hormone for short stature must be administered under the guidance and follow-up of pediatric endocrinology specialists.