Referrals for tall stature in children: a 25-year personal experience

Abstract

Aim: Extreme tall stature may lead to a variety of concerns in tall children and their parents, leading to requests for treatment to reduce final height in some children. This study reviews referrals for tall stature to a single pediatric endocrinologist and results of treatment over 25 years from 1980 to 2004.

Methods: Diagnoses, heights, target heights and estimated final heights at presentation, and final heights and complications in treated patients, were examined by retrospective chart review.

Results: Of 345 referrals, 244 (71%) were girls and 101 (29%) were boys. Of the 68 (19.7%) treated, 53 (78%) were girls and 15 (22%) were boys. Most children had familial tall stature. Treated children were tall for their already tall families. Treatment reduced final heights compared with estimated final heights by (mean +/- standard error of the mean) 4.2 +/- 0.5 cm (P = 0.001) in girls and 5.1 +/- 0.8 cm (P < 0.001) in boys. Minor complications occurred in 27 (51%) girls, including 5 (9.4%) who stopped treatment because of weight gain, and 5 (33%) of boys. In more recent years, girls (but not boys) presented less frequently, were taller at presentation and opted for treatment less often, and at taller estimated final heights than in the earlier years.

Conclusions: Any benefits of high-dose sex steroid treatment of tall children in terms of reduced final height and improved self-image are at the expense of complications in many. Fewer tall girls being referred and treated probably reflects altered attitudes to tallness in society. Such treatment should seldom - if ever - be used in the future.