📏 Short Stature · Growth Hormone Deficiency · Familial · Constitutional Delay · Turner

Schwartz Clinical Handbook — Chapter 71 · Height <3rd percentile · Bone age · Midparental height · IGF‑1 · GH stimulation · SGA · Hypothyroidism · Celiac

Select height percentile, growth velocity (crossing percentiles), bone age (delayed vs normal), parental heights, systemic symptoms (diarrhea, fatigue, cold intolerance), and lab clues (IGF‑1, TSH, celiac panel) → differentiate familial short stature, constitutional delay of growth and puberty (CDGP), growth hormone deficiency (GHD), hypothyroidism, celiac disease, Turner syndrome, and SGA.
⚠️ Red flags: height <3rd percentile with falling percentiles, delayed bone age >2 SD, abnormal IGF‑1 → endocrine referral.

📋 Step 1 — Growth curve & family history
📌 Diagnostic impressions
📖 Schwartz Ch 71

Select height percentile (<3rd, <5th), growth velocity (crossing percentiles), bone age (delayed vs normal), parental heights (midparental target), systemic symptoms (fatigue, cold intolerance, diarrhea), and labs (IGF‑1, TSH, celiac, karyotype) → differentiate familial short stature (normal growth velocity, bone age = chronological), CDGP (delayed bone age, delayed puberty), GHD (poor growth velocity, low IGF‑1), hypothyroidism, celiac disease, Turner syndrome, SGA.

✔️ Familial: height low but parallel to curve, normal bone age, parental short.
✔️ CDGP: delayed bone age, delayed puberty, normal IGF‑1, family history of late bloomers.
✔️ GHD: poor growth velocity (<5 cm/y), delayed bone age, low IGF‑1, MRI pituitary.
✔️ Turner: short stature, webbed neck, delayed bone age, karyotype 45,XO.
✔️ Hypothyroidism: weight gain, fatigue, delayed bone age, elevated TSH.
📘 Schwartz pearls (Chapter 71)
• Bone age: delayed (>2 SD) suggests CDGP, GHD, hypothyroidism.
• Midparental height: (father+mother+13)/2 for boys; (father+mother-13)/2 for girls.
• GH stimulation test for GHD (peak <10 ng/mL).
• Turner syndrome: karyotype, echocardiogram, renal US.
• Celiac disease: tissue transglutaminase IgA, total IgA.