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INTRODUCTION

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The most common reason a child is referred to a pediatric endocrinologist regarding stature is due to concerns about short stature. Occasionally, however, tall stature is the main concern. Although most tall children are constitutionally tall and have no underlying pathology, one must be aware of growth patterns and clinical signs of diseases that lead to increased height in children (Table 517-1).

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TABLE 517-1DIFFERENTIAL DIAGNOSIS OF STATURAL OVERGROWTH
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Cultural differences influence how stature is viewed in girls and boys. In general, short stature in girls is much more likely to be tolerated by parents and medical practitioners, and parents rarely express concern about an excessively tall boy or girl. These cultural expectations can lead to significant delays in the diagnosis of children with true growth abnormalities.

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There are pathologic causes of tall stature including a host of hormonal and genetic disorders as well as nonpathologic causes, or what we call constitutional tall stature.

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CONSTITUTIONAL TALL STATURE

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Normal tall children are repeating the familial pattern of their tall parents. They generally grow at the upper range of normal and sometimes above the 97th percentile. Their growth velocity is also on the upper range of normal, which is required to achieve and maintain tall stature. However, their pattern of growth is normal with no acceleration occurring during childhood, a normal onset and progression of puberty, and attainment of a final height within the range of their mid-parental height. These children have normal development, and they do not present with any abnormalities upon examination.

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Constitutional tall stature is of greater concern in females than in males. Children are sometimes brought to the endocrinologist in the hope of reducing their final height. High-dose sex steroid therapy (estrogen in females and androgens in males) has been used in an effort to close the growth plates early and to decrease the final height. Various studies of these therapies have reported a decrease in final height ranging from 2 to 10 cm in girls and 5 to 10 cm in boys. The effect of therapy depends largely on the timing. The earlier therapy is started, the greater is the reduction in final height. High-dose sex steroid ...

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