• Fahim Ullah Hayatabad Medical Complex, Peshawar
  • Tahir Ghaffar Hayatabad Medi al Complex, Peshawar
  • Ayesha Khan Afridi Khyber Teaching Hospital, Peshawar
  • Ashfaq Ali Hayatabad Medical Complex, Peshawar.
  • Aziz ul hasan Aamir Hayatabad Medi al Complex, Peshawar


Background: Globally children and adolescents with growth failure are referred to specialized units for evaluation and management. We designed this study to determine the cause of short stature in children and adolescents referred to our endocrine unit for evaluation and further management. Methods: This descriptive cross sectional study was performed in the Department of Endocrine, Diabetes and Metabolic Diseases, Hayatabad Medical Complex, Peshawar. Children and adolescents between 2–20 years with height below 2 SDS or less then 3rd percentile for their age and gender were included while those with kyphoscoliosis, thalassemia major, diabetes mellitus type-1 were excluded. Detailed history was obtained followed by detailed physical examination and a pre-set penal of investigations. Results: 73 children with mean chronological age of 11.75.3±4.06 years, 56.31% boys and 43.83% girls (p<0.05) were included. Mean height was 117.28±17.55 cm, -4.23±2.06 SDS below for this population age group. Mean parental height was 156.87±11.82 cm, mean bone age was 8.56±4.03 years while mean bone age delay was 3.23±1.94 years. Common causes found were variants of normal growth present in 38.35%. Constitutional Delay of Growth and Puberty (CDGP) was found in 13.7%, Familial Short Stature (FSS) in 11.0% while overlapping features of both in other 13.7%. Isolated Growth Hormone Deficiency (GHD) was found in 23.3%, primary hypothyroidism in 9.6% and pan-hypopituitarism in 2.7%. Common non endocrine causes found were Turner's syndrome, rickets, chronic anaemia, bronchial asthma and achondroplasia. Conclusion: Isolated GHD, CDGP and FSS, primary hypothyroidism and Turner's syndrome are the most common causes of short stature in our set up.

Author Biographies

Fahim Ullah, Hayatabad Medical Complex, Peshawar

Fellow Resident, Department of Endocinology, Diabetes and Metabolic Diseases

Tahir Ghaffar, Hayatabad Medi al Complex, Peshawar

Fellow Resident, Department of Endocinology, Diabetes and Metabolic Diseases,Hayatabad Medi al Complex, Peshawar

Ashfaq Ali, Hayatabad Medical Complex, Peshawar.

Medical Officer, Department of Endocinology, Diabetes and Metabolic Diseases, Hayatabad Medi al Complex, Peshawar

Aziz ul hasan Aamir, Hayatabad Medi al Complex, Peshawar

Professor and Head of Department of Endocinology, Diabetes and Metabolic Diseases,Hayatabad Medi al Complex, Peshawar, Hayatabad Medi al Complex, Peshawar


Deodati A, Cianfarani S. Impact of growth hormone therapy on adult height of children with idiopathic short stature: systemic review. BMJ 2011;342:c7157.

Schnell FN, Bannard JR. Short Stature in Childhood and Adolescence: Part 1: Medical management. Can Fam Physician 1991;37:2206–13.

Cohen P, Rogol AD, Deal CL, Saenger P, Reiter EO, Ross JL, et at. Consensus statement on diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormones Research Society, and Lawson Wilkins Pediatric Society, and the European Society for Paediatric Endocrinology workshop. J Clin Endocrinol Metab 2008;93(11):4210–17.

Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 2002;109(1):45–60.

Freeman JV, Cole TJ, Chinn S, Jones PRM, White EM, Preece MA. Cross sectional stature and weight reference curves for the UK.1990. Arch Dis Child 1995;73(1):17–24.

Bender MK. Centers for Disease Control and Prevention growth charts versus breastfeeding? Pediatrics 2002;110(3):648–8.

Lindsay R, Feldkamp M, Harris D, Robertson J, Rallison M. Utah Growth Study: growth standards and the prevalence of growth hormone deficiency. J Pediatr 1994;125(1):29–35.

Ahmed ML, Allen AD, Sharma A, Macfarlane JA, Dunger DB. Evaluation of a district growth screening programme: the Oxford Growth Study. Arch Dis Child 1993;69(3):361–5.

Voss LD, Mulligan J, Betts PR, Wilkon TJ. Poor growth in school entrants as an index of organic disease: the Wessex growth study. BMJ 1992;305(6866):1400–2.

Ranke MB. Towards a consensus on the definition of idiopathic short stature. Horm Res 1996(suppl 2):64–6.

Wit JM, Ranke MB, Kelner CJH. ESPE Classification of paediatric endocrine diagnoses. Horm Res 2007;68(Suppl 2):1–120.

Wit JM, Clayton PE, Rogol AD, Savage MO, Saenger PH, Cohen P. Idiopathic Short Stature: definition epidemiology and diagnostic evaluation. Growth Hormone IGF Res 2008;18(2):89–110.

Jancevska A, Gucev ZS, Tasic V, Pop-Jordanova N. Growth hormone deficiency (GHD) and small for gestational age (SGA): genetic alterations. Prilozi 2009;30(2):33–55.

De Mel T. A Study of short stature in a community of Sri Lankan children. 1987:136.

de Mel T, Warnasooriya N, Fonseka C. Growth hormone deficiency in Sri Lanka: a preliminary study. Ceylon Med J 1991;36(3):95–7.

Binder G. Short stature due to SHOX deficiency: genotype, phenotype and therapy. Horm Res Paediatr 2011;75(2):81–9.

Rosillo M, Huber-Lequesne C, Sapin H, Carel JC, Blum WF, Cormier-Diare V. Genotypes and phenotypes of children with SHOX deficiency in France. L Clin Endocrinol Metab 2012;97(7):1257–65.

Benito-Sanz S, Aza-Carmona M, Rodrigueaz-Estevez A, Rica-Etxebarria I, Gracia R, Campos-Barros A, et al. Identification of the first PAR1deletion encompassing upstream SHOX enhancers in a family with idiopathic short stature. Eur J Hum Genet. 2012;20(1):125–127.

Hardin DS. Treatment of short stature and growth hormone deficiency in children with somatotropin (rDNA origin). Biologics 2008;2(4):655–61.

Lifshitz F, Botero D. Worrisome growth. In: Lifshitz F, editor. Pediatric Endocrinology. 5th edition. Vol. 2. New York, NY, USA: Marcel Dekker; 2007. p.1–46.

Kuszmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, et al. CDC growth charts: United States. Adv Data 2000;8(314):1–27.

Abdenur JE, Pugliese MT, Cervantes C, Fort P, Lifshitz F. Alterations in spontaneous growth hormone (GH) secretion and the response to GH-releasing hormone in children with nonorganic nutritional dwarfing. J Clin Endocrinol Metab 1992;75(3):930–34.

Zimmermann MB, Jooste PL, Mabapa NS, Mbhenyane X, Schoeman S, Biebinger R, et al. Treatment of iodine deficiency in school-age children increases insulin-like growth factor (IGF)-I and IGF binding protein-3 concentrations and improves somatic growth. J Clin Endocrinol Metab 2007;92(2):437–42.

Zargar AH, Laway BA, Masoodi SR, Wani AI, Salahuddin M. An etiological profile of short stature in the Indian subcontinent. J Paediatr Child Health 1998;34(6):571–6.

Bhadada SK, Agrawal NK, Singh SK, Agrawal JK. Etiological profile of short stature. Indian J Paediatr 2003;70(7):545–7.

Halac I, Zimmerman D. Evaluating short stature in children. Pediatr Ann 2004;33(3):170–6.

Waheed KA, Irfan K, Ahmad TM, Khan HI. Spectrum of clinical presentation of chronic renal failure in children. Pak Paediatr J 2002;26:167–71.

Queiroz MS, Nery M, Cançado EL, Gianella-Neto D, Liberman B. Prevalence of celiac disease in Brazilian children of short stature. Braz J Med Biol Res 2004;37(1):55–60.

Checkley W, Epstein LD, Gilman RH, Cabrera L, Black RE. Effects of acute diarrhea on linear growth in Peruvian children. Am J Epidemiol 2003;157(2):166–75.

Lam WF, Hau WL, Lam TS. Evaluation of referrals for genetic investigation of short stature in Hong Kong. Chin Med J (Engl) 2002;115(4):607–11.

Rogol AD. Causes of short stature. In: Rose BD, (edi). Up-to date 15.1 [CD Rom]. Waltham MA: upto-date; 2007.

Giovenale D, Meazza C, Cardinale GM, Sposito M, Mastrangelo C, Messini B, et al. The prevalence of growth hormone deficiency and celiac disease in short children. Clin Med Res 2006;4(3):180–3.

Rose SR, Vogiatzi MG, Copland KC. A general pediatric approachto evaluating a short child. Pediatr Rev 2005;26(11):410–20.

Tanner JM, Davies PS. Clinical longitudinal standards for height and height velocity for North American children. J Pediatr 1985;107(3):317–29.

Tanner JM, Goldstein H, Whitehouse RH. Standards for children's height at ages 2-9 years allowing for heights of parents. Arch Dis Child 1970;45(244):755–62.

Grote FK, Oostdijk W, de Muinck Keizer-Schrama SM, Dekker FW, Verkerk PH, Wit JM. Growth monitoring and diagnostic work-up of short stature: an international in ventorization. J Pediatr Endocrinol Metab 2005;18(11):1031–8.

Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of Hand and Wrist, 2nd ed. Stanford. Stanford University Press; 1959.

Moayeri H, Aghighi Y. A prospective study of etiology of short stature in 426 short children and adolescents. Age 2004;14(1.7):13–3.

Colaco P, Desai M. Identification of a child with short stature. Indian Paediatr 1990;27(11):1159–64.

Voss LD, Bailey BJ, Mulligan J, Wilkin TJ, Betts PR. Short stature and school performance -- the Wessex growth study. Acta Paediatr Scand Suppl 1991;377:29–31.

Lashari SK, Korejo HB, Memon YM. To determine frequency of etiological factors in short statured patients presenting at an endocrine clinic of a tertiary care hospital. Pak J Med Sci 2014;30(4):858–61.

Waqar Rabbani M, Imran Khan W, Bilal Afzal A, Rabbani W. Causes of short stature identified in children presenting at a tertiary care hospital in Multan Pakistan. Pak J Med Sci 2013;29(1):53–7.

Grimberg A, Kutikov JK, Cucchiara AJ, Sex difference in patients referred for evaluation of poor growth, J Pediatr 2005;146(2):212–6.

Himes JH. Minimum time intervals for serial measurement of growth in recumbent length or stature of individual children. Acta Paediatr 1999;88(2):120–5.

Consideration related to the use of recombinant growth hormone in children. American Academy of Paediatrics committee on drugs and committee on bioethics. Pediatrics 1977;99(1):122–9.

Hardin DS, Woo J, Butsch R, Huett B. Current prescribing practice and opinions about growth hormone therapy: results of nationwide survey of paediatrics endocrinologist. Clin Endocrinol 2007;66(1):85–94.

Sultan M, Afzal M, Qureshi SM, Aziz S, Lutfullah M, Khan SA, et al. Etiology of Short Stature in Children. J Coll Physicians Surg Pak 2008;18(8):493–97.

Awan TM, Sattar A, Khattak EG. Frequency of growth hormone deficiency in short statured children. J Coll Physicians Surg Pak 2005;15(5):295–8.



Most read articles by the same author(s)