SCIENTIFIC LETTER

Profile and Height Outcomes of Children with Short Staturein North India: An Experience from a Tertiary Care Centre

Deep Dutta & Krishna Biswas & Richa Arora &

Navjyoti Barman & Divendu Bhushan &

Bhanu K. Bhakhri

Received: 18 May 2012 /Accepted: 7 March 2013# Dr. K C Chaudhuri Foundation 2013

To the Editor: The ongoing dynamicity in the populationin terms of change in nutritional status, improved edu-cation, awareness and access to health care is expectedto bring changes in the etiologies causing short stature(SS). This study aimed to evaluate the current etiolog-ical trends for SS and the effect of treatment on finalheight. Retrospective analysis of records of childrenreferred for SS from 2003–2007 with at least 4 years followup was done in the Department of Endocrinology,Vardhman Mahavir Medical College & Safdarjung Hos-pital, New Delhi. (Fig. 1). SS was defined as height<3rd percentile and/or height velocity <5th percentilefor chronological age.

Records of 139 children [68 girls; 71 boys; age of pre-sentation: 11.34±3.71 y (Range 2–21 y)] were analyzed ofwhich 74 (53.24 %) had reached 18 y age. This studyhighlights the predominantly late presentation of childrenwith SS in India. Familial short stature (FSS) (36, 26 %) wasthe most common cause of SS followed by hypothyroidism(26, 19 %), growth hormone deficiency (GHD) (19, 14 %),

constitutional delay in growth and puberty (CDGP) (17,12 %), genetic syndromes [Turner’s (n=7); Down’ssyndrome (n=4)] (11, 8 %), Celiac disease (8, 6 %),nutritional (8, 6 %), achondroplasia/hypochondroplasia(6, 4 %), chronic disease (2, 1 %) and idiopathic(6,4 %). FSS and CDGP together constitute normalvariant SS (NVSS) and is the most common cause ofSS in our country, constituting 9 % [3], 16 % [4] and20 % [5] of all SS children in different studies and38 % in our study. This increased proportion of childrenwith NVSS in our series may reflect the increasedawareness in the society and increased healthcare seek-ing. Being a referral centre our patient profile is likelyto be skewed and it is likely that NVSS is even morecommon in the population.

There was a significant difference in the presenting heightstandard deviation score (SDS) (P=0.002), final height SDS(P<0.001) and the change in height SDS (Δ Ht SDS)(P<0.001) depending on the etiology of SS (Table 1). Maxi-mum height improvement (ΔHt SDS) was seen in treatedGHD children followed by treated hypothyroid andCDGP. Poor height outcome of children with Celiac diseasein our study may be the result of delayed diagnosis and lack ofcompliance to gluten free diet. Poor height outcomes in chil-dren with achondroplasia/hypochondroplasia and SS due tosyndromes reflect the limited growth potential in thesechildren. Endocrine disorders should be actively lookedfor, since they comprise of a third of children with SS andshow maximum improvement in height on treatment. Thoughthere has been increased healthcare seeking,it is quite late asevident from our study. Increased awareness among generalpopulation and pediatricians would help early detection oftreatable cases and better height of the population.

K. Biswas :R. Arora :N. Barman :D. BhushanDepartment of Endocrinology, Vardhman Mahavir MedicalCollege & Safdarjung Hospital, New Delhi, India

D. Dutta (*)Department of Endocrinology & Metabolism, IPGMER & SSKMHospital, Kolkata 700020, West Bengal, Indiae-mail: deepdutta2000@yahoo.com

B. K. BhakhriDepartment of Pediatrics, Postgraduate Institute ofMedical Sciences,Rohtak, Haryana, India

Indian J PediatrDOI 10.1007/s12098-013-1006-y

References

1. Agarwal DK. Agarwal KN Physical growth in Indian affluentchildren (Birth to 6 years). Indian Pediatr. 1994;34:377–413.

2. Agarwal DK, Agarwal KN, Upadhyaya SK, Mittal R, Prakash R,Rai S. Physical and sexual growth pattern of affluent Indian childrenfrom 5 to 18 years of age. Indian Pediatr. 1992;29:1203–68.

3. Bhadada SK, Bhansali A, Ravikumar P, Kochhar R, Nain CK, DuttaP, et al. Changing scenario of etiological profile of short stature inIndia- growing importance of celiac disease: A study from a tertiarycare centre. Indian J Pediatr. 2011;78:41–4.

4. Bhadada SK, Agarwal NK, Singh SK, Agarwal JK. Etiologicalprofile of short stature. Indian J Pediatr. 2003;70:545–7.

5. Colaco P, Desai M. Identification of a child with short stature.Indian Pediatr. 1990;27:1159–64.

Fig. 1 Study protocol

Table 1 Height outcomes in children with short stature

Patient group Age of presentation Initial height SDS Target height SDS Final height SDS Δ Height SDS

FSS (n=36) 12.29±4.37 −2.95±1.31 −2.06±1 −2.18±0.89 0.69±0.98

CDGP (n=17) 12.31±2.54 −1.91±0.78 −1.34±0.8 −0.77±0.53 1.2±0.68

Hypothyroidism (n=26) 11.07±4.4 −3.6±2.96 −1.6±1.30 −2.05±2.17 1.76±1.86

GHD/MPHD untreated (n=15) 11.6±4.5 −3.4±1.70 −1.58±0.60 −4.12±1.35 −1.12±1.3

GHD/MPHD treated (n=4) 11.57±5.07 −3.91±1.16 −1.43±0.93 −1.47±1.38 2.44±1.07

Genetic syndromes SS (n=11) 11.3±4.4 −3.81±1.79 −0.96±1.83 −4.21±1.84 −0.40±1

Celiac disease (n=8) 11.87±3.6 −2.14±1.31 −1.88±1.44 −2.85±0.51 −0.7±1.16

Nutritional (n=8) 10±4.55 −2.37±1.25 −1.45±1.02 −1.29±0.99 0.71±0.38

Hypochondroplasia/achondroplasia (n=6) 10.25±4.99 −6.64±2.4 −1.26±0.89 −5.99±1.52 −1.29±1.85

Chronic disease (n=2) 7±7.07 −4.02±0.99 −0.69±0.48 −4.15±0.35 −0.12±0.64

ISS (n=6) 11.66±4.76 −3.81±1.79 −1.14±0.33 −4.21±1.85 −0.41±1

P value* NS 0.002 NS <0.001 <0.001

All values expressed as mean±standard deviation; P<0.05 considered statistically significant; *One way ANOVA; NS Not significant; SDS wascalculated using growth charts and tables developed from affluent urban Indian children by Agarwal et al. [1, 2]

FSS Familial short stature; CDGP Constitutional delay in growth and puberty; Hypothyroid Primary & secondary hypothyroidism, congenitalhypothyroidism; GHD Growth hormone deficiency; MPHD Multiple pituitary hormone deficiency; SS Short stature; ISS Idiopathic short stature;ΔHt SDS [(Presenting Ht SDSX-1)- (Final Ht SDSX-1)]; Ht Height; SDS Standard deviation score

Indian J Pediatr