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Most tall children are normal, and their stature is linked to genetic background and an optimal environment for growth. Tall stature is concerning only if a child’s tallness is inappropriate for parental height or when linear growth velocity accelerates inappropriately. A number of endocrine and nonendocrine disorders cause excessive linear growth during childhood and adolescence (Table 524-1). Endocrine causes of accelerated growth include growth hormone (GH) excess or acromegaly; thyrotoxicosis; excess androgenic hormones, as in congenital adrenal hyperplasia and virilizing tumors; and sexual precocity. The latter disorders are readily apparent on physical examination because of accompanying signs of androgen excess or sexual maturation. Adolescents with hypogonadotropic hypogonadism can also be tall and have a eunuchoid habitus. Other clinical entities that can cause an increase in absolute height or accelerated height velocity include obesity, Marfan syndrome, homocystinuria, total lipodystrophy, neurofibromatosis, and chromosomal abnormalities such as Klinefelter syndrome, and 48XXYY and 47XYY syndromes.

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Table 524-1. Differential Diagnosis of Statural Overgrowth
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When the prediction of adult height for a girl exceeds 183 cm (6 feet), height is considered excessive by some families. Concern about the final adult height of boys is rarely about overgrowth. In general, tall children have tall parents, their body proportions are normal, their height has been greater than the 97th percentile since early childhood, and height velocity is within the normal range. Children with constitutional tall stature may have augmented growth hormone (GH) responses to some stimuli and increased levels of insulinlike growth factor I (IGF-I).1,2

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Treatment of excessively tall girls is a therapeutic dilemma for pediatricians and endocrinologists. Considerable data suggest that high-dose estrogen therapy markedly restricts final height to less than predicted. The vagaries of height prediction and the ever-present risk of dangerous long-term side effects of hormonal therapy dictate careful consideration of each patient’s clinical state, self-image, and desire for treatment. The use of high-dose estrogen in otherwise normal children must be weighed against the known (and unknown) toxicity of such therapy,3-9 including nausea, weight gain, edema, and hypertension. Other potential problems, such as thromboembolism, cystic hyperplasia of the breast, endometrial hyperplasia, and cancer, have not been definitively related ...

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