Short stature is defined as a condition in which the height of an individual is in the 3rd percentile for the mean height of a given age, sex, and population group. It can be assessed through various anthropometric instruments. Short stature can be caused by hormonal, genetic, and developmental pathology. The diagnosis of short stature requires biochemical and radiological tests, including nutritional and hormonal assessment, as well as estimation of bone age. The primary management of short stature aims at alleviating the underlying cause and treating the associated psychosocial distress.
Stature is scientifically known as height vertex. It is defined as the height of a person taken from the ground to the vertex when the head is held in the Frankfurt horizontal plane (F-H plane). It can be assessed through various instruments such as measuring tape, stadiometer, anthropometric rod, infantometer, etc. According to Ranke (1996), “Short stature is defined as a condition in which the height of an individual is two standard deviations (SD) below the corresponding mean height of a given age, sex and population group.” In medical terminology, it is known as “dwarfism.” There are two types of short stature, proportionate short stature (PSS) and disproportionate short stature (DSS). PSS is diagnosed when the individual has the usual proportion in the limbs and trunk height, whereas when this proportion is absent, and the individual shows a great difference in his sitting and standing height, the individual is said to have DSS. In literature, various terminologies are used to describe short stature based on the cause. These include idiopathic short stature, familial short stature, constitutional short stature, constitutional delay of growth, and adolescence (CDGA), etc.
Stature is a hereditary trait and controlled by both genetic as well as environmental factors. Short stature is caused by four major reasons.
The stature of a person is a result of interactions between genetic adaptations and climatic conditions. The extremely cold climate favors short and round individuals, whereas individuals from hot climate are generally tall and thin, according to Allen's (1877) and Bergmann's rules (1847). The distal limb segments in Equatorial Africans are longer than those from more temperate climates, following Allen's rule. Therefore, while an individual can have normal stature according to his population group, it can result in short stature in relation to the entire population. Because of these population variations, the mean height of an individual is always compared with the mean height of that specific population only.
According to the definition, 97.5% of the population belongs to normal and tall stature and only -2 SD i.e., 2.5% of the population has short stature. However, the prevalence rate may vary with the climatic conditions of the geographical area.
Prevalence of Short Stature
Saudi Arabia recorded a relatively high frequency of short stature, i.e., in boys, the study found a prevalence of 11.3% in children and 1.8% in adolescents. In girls, short stature was found to be prevalent in 10.5% of children and 1.2% in adolescents.  However, the prevalence rate of short stature in Jordan was found to be 4.9%.
A study on the Galician population from Spain has recorded 1% of children with short stature due to malnutrition out of the 7438 recruited children. In contrast, a longitudinal study conducted in Kobe, Japan, on 27228 infants, who were born small for gestational age (SGA), documented that only 15 infants i.e., a prevalence rate of 0.06%, met the criteria for GH treatment. Whereas only 555 children out of 114881 children in the United States had short stature.
A study from South India recorded the prevalence rate of 2.86% in school-going children. The study examined 15644 children, out of which 448 (2.86%) had short stature. The major reasons behind short stature were genetics and constitutional delay in growth in 66.67% children, whereas 13.79% and 9.20% had hypothyroidism and growth hormone deficiency, respectively. Only 6.69% of children were reported to have short stature caused by malnutrition.
Sex-related Short Stature
A retrospective study in South China showed a difference in the frequency of hospital-reported cases. More boys were admitted than girls. This may be due to the higher prevalence of social pressures and expectations from males as compared to females.
Meanwhile, the prevalence rate in Rosario, Argentina, was found to be statistically higher in females (16.4%) than males (8.4%) (p<0.001). The short stature in females was related to age, weight, and abdominal obesity.
Age-related Short Stature
Any individual who has not attained skeletal maturation, i.e., the union of epiphyseal plates, can be affected.
The diagnosis requires in-depth interviews, anthropometric measurements, analysis of ancestry, biochemical investigations, etc. The steps involved in the diagnosis are listed below:
The medical investigation for diagnosis of short stature includes a range of biochemical and radiological tests that are correlated with the clinical features. These include:
The primary management of short stature should aim at alleviating the underlying cause. Short stature caused due to underlying hormonal deficiency should be managed with hormonal treatment, short stature due to bone diseases should aim at treating the disease.
Various hormonal treatments are available today to treat the underlying hormonal condition giving rise to short stature and should be prescribed as soon as possible. This will not only treat the underlying cause and prevent the development of short stature but also prevent its psychosocial effects. These include treating growth hormonal deficiencies and constitutional growth delays with gonadotropin-releasing hormone analogs (GnRHa), aromatase inhibitors, recombinant human insulin-like growth factor- 1 (RhIGF-1), low-dose androgen therapy, recombinant human growth hormone (rhGH) , etc.
In addition to treating the underlying cause, individuals suffering from psychosocial distress as a result of their short stature should be provided with psychosocial counseling aimed at imparting coping mechanisms.
Impact of short stature on psychology:
Numerous results have shown that the personality of a person is determined by their stature. During the selection of partners for marriage, stature plays an important role. Tall statured individuals are mostly preferred. In spite of this, short-statured individuals are always belittled by their peers and family, in schools, colleges as well as in the workplace. They are often teased and bullied relentlessly, resulting in social isolation and thus, are at high risk of having psychosocial distress, especially during their adolescence. They also encounter difficulties in academics, family relationships, social relationships, office environment, etc.
Early diagnosis and management of preventable conditions can lead to a significant improvement in the condition and accelerate growth to match their peers. Lionel Messi, regarded as one of the greatest footballers, is reported to have undergone treatment for growth hormone deficiency with a positive outcome.
While the prognosis for short stature in individuals that have attained skeletal maturity is extremely poor, the associated psychosocial stress can be adequately managed with counseling.
The complications of short stature are often more dramatic in women, preventing the individual from bearing and giving birth to a child. This can further aggravate the anguish in an already distressed individual. Other complications include the stunted growth of internal organs, causing a predilection to various diseases and conditions.
The importance of patient education is two folds. The first is the detection and management of preventable conditions causing short stature. An equally important aspect of patient education is the counseling of patients and family members to assist in improving the quality of life in individuals that have already attained full maturation. Counseling can also help individuals in dealing with the effects of bullying, social isolation, and stress associated with short stature.
Stature is used to monitor physical growth and development during childhood. Stature is an indicator of malnutrition (including gestational malnutrition) and one of the constituents of BMI (body mass index); this can further help in the assessment of nutritional uptake. If the underlying cause of short stature is known, the related treatment can be provided.
Short stature has a psychosocial impact on an individual, and therefore, the behavior (bullying behavior, isolated behavior, etc.) of a person can be improved by counseling.
Anthropology is a human science, with human auxology or human growth and development being a major branch of biological anthropology. The focus of a biological anthropologist is the assessment of physical growth and development during life, which can be examined through the stature of an individual. Anthropologists study the various reasons behind short stature in a population and can assist in recording the family history, emergence of puberty, as well as genetic diseases. Anthropologists also help in assessing growth patterns and nutritional uptake among different population groups and help evaluate the risk factors, including diet, environment, and genetics.
Identification is an essential part of forensic investigations. Where identification cannot be established, forensic investigators develop the biological profile, on the basis of ancestry, age, sex, and stature. While stature alone cannot be used to establish identity, it assists in crime investigation by eliminating suspects, especially so with short stature.
Medical personnel, especially those working in child and maternal health, may be required to intervene in cases of short stature. Adequate knowledge on the underlying conditions, their treatment as well as the need for counseling can greatly improve patient outcome and not only prevent the development of short stature but also assist in improving the quality of life of individuals that have already attained full maturation.
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