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Tall stature (Aetiology (Congenital/genetic Marfan's syndrome …
Tall stature
Aetiology
Congenital/genetic
Marfan's syndrome
Kleinfelter syndrome
Metabolic
Obesity (advanced puberty)
Idiopathic
Constitutional (tall patents)
Endocrine
Thyrotoxicosis
Precocious puberty
CAH
Gigantism
Diagnosis
Examination
General
Dysmorphic features, signs
of endocrine disease
Investigations
Bloods
FBC, U+E, LFT, TFT (hyper),
Hormones (oestrogen, testosterone, LH, FSH, GH, cortisol)
Karyotyping (Kleinfelters)
Imaging
X-ray wrist/hands: skeletal age
Bedside
Obs
Measurements (height, weight, BMI)
Growth chart and parents height
Tanner staging
History
DH
Meds, allergies
FH
Endocrine disease, congenital disease
PMH
Growth and development
Known medical conditions
Vaccinations
SH
Living arrangements, school,
diet, exercise
PC/HPC
Tall stature
Management
Conservative
Information, advice, support
Identify and treat cause
Medical
Hormone therapy
Indication: prepubertal/early pubertal excess growth
E.g. oestrogen (female), testosterone (male)
MOA: accelerates puberty, accelerates
epiphyseal fusion so reducing final growth
Surgical
Epiphyseal destruction
Indication: extreme cases
Definition
Stature >2SD from
median height
Epidemiology
Less common complaint
vs short stature
Complications
Psychosocial
Low self esteem
Treated older than age