Endocrine Abstracts

JOINT2786

Introduction: Tall stature is defined as a height greater than or equal to +2 standard deviations (SD) on the reference growth curves, or a height greater than 1.5 SD in relation to the genetic target height. While stunted growth is a frequent reason for consultation, overgrowth is often a rarer and more specialized problem. The interest lies in the identification and management of the cause, as well as the indication of a restraining treatment when the psychological repercussions are significant.

Observation: This is a 14-YEAR-OLD patient with no notable pathological history, menarche at the age of 11, who consulted us for tall stature with no similar cases in the family: A height of 174 cm situated between plus 2DS and3DS on the reference curves with a target height of 164 cm, greater than 2DS of the genetic height, the pubertal stage is S4P4, there were no dysmorphic features or signs of associated hyperandrogenism in our patient, the karyotype was normal, the thyroid work-up was normal FSH:3.9UI/L LH:2.8UI/l OESTRADIOL:29.7 pg/ml IGF1: 325 ng/ml z score -0.42. pituitary MRI was without abnormality and bone age was 13 years. a pre-therapeutic blood and morphological workup was requested which was without anomaly.

Discussion: Normal growth requires the integrity of the endocrine and bone systems, regulated by intrinsic (genetic) and extrinsic factors. The causes of early stature are likely to be genetic, endocrine or constitutional. Depending on the presence of body dysmorphia and disproportion, and neurodevelopmental disorders such as sotos, marfan or klinfelter sd (chromosomal anomaly). And for endocrine causes, the existence of hyperthyroidism, an excess of sex hormones as in aromatase deficiency, or GH hypersecretion in somatotropic adenomas. The diagnosis of contitutional tall stature remains a diagnosis of elimination after a rigorous search for other causes with karyotyping. In our patient, no cause was identified, but the indication for treatment was given in view of the psychological impact. Therapeutic options are limited, and only high-dose sexual steroids have benefited from sufficient clinical trials. Treatment is most effective when administered before the bone age of 12 years. In our patient, the choice of treatment was ethynil estradiol 6 mg/day, after elimination of contraindications to this treatment, combined with a progestin for 10 days.

Conclusions: Any child presenting with tall stature should be carefully evaluated to exclude any underlying pathology. Psychological impact remains the main indication before starting treatment.