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Short stature refers to a height of a human which is below typical. Whether a person is considered short depends on the context. Because of the lack of preciseness, there is often disagreement about the degree of shortness that should be called ''short''.
Dwarfism Dwarfism is a condition wherein an organism is exceptionally small, and mostly occurs in the animal kingdom. In humans, it is sometimes defined as an adult height of less than , regardless of sex; the average adult height among people with dw ...
is the condition of being very short, often caused by a medical condition. In a medical context, short stature is typically defined as an adult height that is more than two
standard deviation In statistics, the standard deviation is a measure of the amount of variation or dispersion of a set of values. A low standard deviation indicates that the values tend to be close to the mean (also called the expected value) of the set, whil ...
s below a population’s
mean There are several kinds of mean in mathematics, especially in statistics. Each mean serves to summarize a given group of data, often to better understand the overall value ( magnitude and sign) of a given data set. For a data set, the '' ar ...
for age and gender, which corresponds to the shortest 2.3% of individuals in that population. The median or typical adult height in developed countries is about for men and for women.


Causes

Shortness in children and young adults nearly always results from below-average
growth Growth may refer to: Biology * Auxology, the study of all aspects of human physical growth * Bacterial growth * Cell growth * Growth hormone, a peptide hormone that stimulates growth * Human development (biology) * Plant growth * Secondary grow ...
in childhood, while shortness in older adults usually results from loss of height due to kyphosis of the
spine Spine or spinal may refer to: Science Biology * Vertebral column, also known as the backbone * Dendritic spine, a small membranous protrusion from a neuron's dendrite * Thorns, spines, and prickles, needle-like structures in plants * Spine (zoolo ...
or collapsed
vertebra The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...
e from
osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone a ...
. The most common causes of short stature in childhood are constitutional growth delay or familial short stature. From a medical perspective, severe shortness can be a variation of normal, resulting from the interplay of multiple familial genes. It can also be due to one or more of many abnormal conditions, such as chronic (prolonged)
growth hormone Growth hormone (GH) or somatotropin, also known as human growth hormone (hGH or HGH) in its human form, is a peptide hormone that stimulates growth, cell reproduction, and cell regeneration in humans and other animals. It is thus important in ...
or
thyroid hormone File:Thyroid_system.svg, upright=1.5, The thyroid system of the thyroid hormones T3 and T4 rect 376 268 820 433 Thyroid-stimulating hormone rect 411 200 849 266 Thyrotropin-releasing hormone rect 297 168 502 200 Hypothalamus rect 66 216 386 25 ...
deficiency,
malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
, disease of a major organ system, mistreatment, treatment with certain drugs,
chromosomal A chromosome is a long DNA molecule with part or all of the genetic material of an organism. In most chromosomes the very long thin DNA fibers are coated with packaging proteins; in eukaryotic cells the most important of these proteins ar ...
deletions.
Human growth hormone Growth hormone (GH) or somatotropin, also known as human growth hormone (hGH or HGH) in its human form, is a peptide hormone that stimulates growth, cell reproduction, and cell regeneration in humans and other animals. It is thus important in ...
(HGH) deficiency may occur at any time during infancy or childhood, with the most obvious sign being a noticeable slowing of growth. The deficiency may be genetic. Among children without
growth hormone deficiency Growth hormone deficiency (GHD), or human growth hormone deficiency, is a medical condition resulting from not enough growth hormone (GH). Generally the most noticeable symptom is that an individual attains a short height. Newborns may also prese ...
, short stature may be caused by
Turner syndrome Turner syndrome (TS), also known as 45,X, or 45,X0, is a genetic condition in which a female is partially or completely missing an X chromosome. Signs and symptoms vary among those affected. Often, a short and webbed neck, low-set ears, low h ...
or Noonan syndrome,
chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years. Initially generally no symptoms are seen, but later symptoms may include leg swelling, feeling tired, vo ...
, being small for gestational age at birth,
Prader–Willi syndrome Prader–Willi syndrome (PWS) is a genetic disorder caused by a loss of function of specific genes on chromosome 15. In newborns, symptoms include weak muscles, poor feeding, and slow development. Beginning in childhood, those affected become ...
, Wiedemann-Steiner syndrome, or other conditions. Genetic skeletal dysplasias also known as osteochondrodysplasia usually manifest in short-limbed disproportionate short stature. When the cause is unknown, it is called '' idiopathic short stature''. Short stature can also be caused by the bone plates fusing at an earlier age than normal, therefore stunting growth. Normally, the bone age is the same as the biological age but for some people, it is older. For many people with advanced bone ages, they hit a growth spurt early on which propels them to average height but stop growing at an earlier age. However, in some cases, people who are naturally shorter combined with their advanced bone age, end up being even shorter than the height they normally would have been because of their stunted growth. Some of the reasons growth development may slow include: Genetics. When a child’s parents and grandparents are short, the child may also be short; this is known as familial short stature. Also, the target height is merely an estimate and some children simply don't grow as tall as expected. Genetic conditions. Several genetic syndromes can lead to short stature, including Prader-Willi syndrome,
Turner syndrome Turner syndrome (TS), also known as 45,X, or 45,X0, is a genetic condition in which a female is partially or completely missing an X chromosome. Signs and symptoms vary among those affected. Often, a short and webbed neck, low-set ears, low h ...
and Noonan syndrome. Chronic diseases. Growth hormone is produced by the pituitary gland, located in the middle of the brain. Therefore, chronic medical problems that affect the pituitary gland may also affect growth. For example, radiation to the brain can affect pituitary function, so pediatric cancer or its treatment can lead to short stature. Gastrointestinal diseases that impair nutrition, such as inflammatory bowel disease and celiac can affect growth, can also be a cause. Many other conditions can also delay the growth rate, including
hypothyroidism Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as ...
, heart disease, kidney disease, immunological disease and several other endocrine disorders.
Growth hormone deficiency Growth hormone deficiency (GHD), or human growth hormone deficiency, is a medical condition resulting from not enough growth hormone (GH). Generally the most noticeable symptom is that an individual attains a short height. Newborns may also prese ...
. Some children simply don't produce enough growth hormone, including those born with a poorly developed pituitary gland. Malnutrition. This is caused by an inadequate food supply, an eating disorder, or an underlying condition or treatment that affects appetite, lack of nourishment is a common cause of growth delay. Psychosocial stress.exposure to violence because of war or famine or just being in a home environment that’s not very nurturing, children can also experience a psychosocial stress that keeps them from growing properly,” Dr. Patel says. “That can be reversed just by removing them from the stressful environment.”


Classification

Chronic illnesses, malnutrition, endocrine, metabolic disorders or chromosomal anomalies are characterized by proportionate short stature. On the other hand, most genetic skeletal dysplasias are known for short stature that may be proportionate or disproportionate. Disproportionate short stature can be further subdivided as specified by the body segments affected by shortening, namely limbs versus trunk:Panda A, Gamanagatti S, Jana M, Gupta AK (2014)
"Skeletal dysplasias: A radiographic approach and review of common non-lethal skeletal dysplasias." ''World Journal of Radiology''
6 (10):808-25. . .
* Short-limb short stature in which there is limb shortening as achondroplasia, hypochondroplasia, pseudoachondroplasia and multiple epiphyseal dysplasia. * Short-trunk short stature in which there is trunk shortening as spondyloepiphyseal dysplasia and mucopolysaccharidosis Short-limb short stature can be further subcategorised in accordance with limb segment affected by shortening. These subcategories of limb shortening include, rhizomelic (humerus and femur), mesomelic (radius, ulna, tibia and fibula) and acromelic (hands and feet). Anthropometric measurements provide are very beneficial tools to the diagnostic process of genetic skeletal dysplasias. The anthropometric measurements include height, sitting height, arm span, upper/ lower-body segment ratio, sitting height/height ratio, and arm span/height ratio for age. They also aid in the differential diagnosis of skeletal dysplasia subtypes.


Treatment

The decision to treat is based on a belief that the child will be disabled by being extremely short as an adult, so that the risks of treatment (including sudden death) will outweigh the risks of not treating the
symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...
of short stature. Although short children commonly report being teased about their height, most adults who are very short are not physically or psychologically disabled by their height. However, there is some evidence to suggest that there is an inverse linear relationship with height and with risk of suicide. Treatment is expensive and requires many years of injections with human growth hormones. The result depends on the cause, but is typically an increase in final height of about taller than predicted. Thus, treatment takes a child who is expected to be much shorter than a typical adult and produces an adult who is still obviously shorter than average. For example, several years of successful treatment in a girl who is predicted to be as an adult may result in her being instead. Increasing final height in children with short stature may be beneficial and could enhance health-related quality of life outcomes, barring troublesome side effects and excessive cost of treatments.


Cost

The cost of treatment depends on the amount of growth hormone given, which in turn depends on the child's weight and age. One year's worth of drugs normally costs about US$20,000 for a small child and over $50,000 for a teenager. These drugs are normally taken for five or more years.


Cultural issues

From a social perspective shortness can be a problem independently of the cause. In many societies there are advantages associated with taller stature and disadvantages associated with shorter stature, and vice versa. Pharmaceutical companies
Genentech Genentech, Inc., is an American biotechnology corporation headquartered in South San Francisco, California. It became an independent subsidiary of Roche in 2009. Genentech Research and Early Development operates as an independent center within ...
and Eli Lilly, makers of human growth hormone, have worked to
medicalize Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evid ...
short stature by convincing the public that short stature is a
disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
rather than a natural variation in human height. Limiting sales of the hormone to children diagnosed with
growth hormone deficiency Growth hormone deficiency (GHD), or human growth hormone deficiency, is a medical condition resulting from not enough growth hormone (GH). Generally the most noticeable symptom is that an individual attains a short height. Newborns may also prese ...
, rather than being short for any reason, limited their sales market. Expanding it to all children whose height was below the third percentile would create 90,000 new customers and US$10 billion in revenue. In the early 1990s, they paid two US charities, the Human Growth Foundation and the
MAGIC Foundation The MAGIC Foundation (short for Major Aspects of Growth in Children) is an American non-profit organization which helps families of children diagnosed with a wide variety of different growth impacting medical conditions through education, networ ...
, to measure the height of thousands of American children in schools and public places, and to send letters urging medical consultations for children whose height was deemed low. Parents and schools were not told that the charities were being paid by the drug companies to do this. Paired with a campaign to advertise the hormone to physicians, the campaign was successful, and tens of thousands of children began receiving HGH. About half of them do not have
growth hormone deficiency Growth hormone deficiency (GHD), or human growth hormone deficiency, is a medical condition resulting from not enough growth hormone (GH). Generally the most noticeable symptom is that an individual attains a short height. Newborns may also prese ...
, and consequently benefited very little, if at all, from the hormone injections. Criticism of the
universal screening Screening, in medicine, is a strategy used to look for as-yet-unrecognised conditions or risk markers. This testing can be applied to individuals or to a whole population. The people tested may not exhibit any signs or symptoms of a disease, or t ...
program eventually resulted in its end.


Advantage

Short stature decreases the risk of venous insufficiency.


History

During
World War I World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was List of wars and anthropogenic disasters by death toll, one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, ...
in Britain, the minimum height for soldiers was . Thus thousands of men under this height were denied the opportunity to fight in the war. As a result of pressure to allow them entry, special " Bantam Battalions" were created composed of men who were to . By the end of the war there were 29 Bantam Battalions of about 1,000 men each. Officers were of normal size.


See also

*
Dwarfism Dwarfism is a condition wherein an organism is exceptionally small, and mostly occurs in the animal kingdom. In humans, it is sometimes defined as an adult height of less than , regardless of sex; the average adult height among people with dw ...
*
List of shortest people This list includes the shortest ever verified people in their lifetime or profession. The entries below are broken down into different categories which range from sex, to age group and occupations. Most of the sourcing is done by Guinness World ...
* National Organization of Short Statured Adults * Primordial dwarfism *
Psychosocial short stature Psychosocial short stature (PSS) is a growth disorder that is observed between the ages of 2 and 15, caused by extreme emotional deprivation or stress. The symptoms include decreased growth hormone (GH) and somatomedin secretion, very short sta ...
—growth inhibition caused by extreme stress * Pygmy


References


External links

{{Nutritional pathology Human height Symptoms and signs