Clinical practice. Short stature in childhood--challenges and choices.
Clinical practice. Short stature in childhood--challenges and choices.
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DOI：
10.1056/nejmcp1213178
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发表时间：
2013-03-28
期刊：
影响因子：
--
通讯作者：
Cuttler L
中科院分区：
文献类型：
--
作者：
Allen DB;Cuttler L
临床要点儿童期身材矮小 当儿童身高缺陷严重（<年龄的第 1 个百分位）、生长速度异常缓慢（<骨龄的第 10 个百分位）、预测身高与父母中间身高显着不同或身体比例异常时，需要对儿童期身材矮小进行全面评估。人生长激素治疗可提高生长速度，适度增加成年身高，迄今为止已被证明是安全的，但价格昂贵且对于基本健康的儿童，长期风险与获益比仍不确定。对于大多数身材矮小的儿童来说，观察和保证是合理的，因为缺乏良好的证据将身材矮小与心理伤害联系起来，或者显示生长促进治疗的长期心理社会益处。低剂量口服氧雄龙是一种有效且相对便宜的加速生长选择，但尚未证明它可以增加成年身高。
Key Clinical PointsShort Stature in ChildhoodThorough evaluation of short stature in childhood is warranted when the child's height deficit is severe (<1st percentile for age), the growth rate is abnormally slow (<10th percentile for bone age), the predicted height differs significantly from midparental height, or the body proportions are abnormal.Human growth hormone treatment increases the growth rate, modestly increases adult height, and has been shown to be safe thus far, but it is expensive and the long-term risk:benefit ratio for essentially healthy children remains uncertain.Observation and reassurance are reasonable for most children with short stature, given the lack of good evidence linking short stature with psychological harm or showing a long-term psychosocial benefit with growth-enhancing therapy.Low-dose oral oxandrolone is an effective and relatively inexpensive option for growth acceleration, but it has not been shown to increase adult height.