Abstract 16: Tall stature: presenting symptom of the wide spectrum of endocrine disorders

Objective: To report our experience with the diagnostic evaluation of children and adolescents presenting with tall stature as a prominent symptom. Methods: This retrospective case series includes four patients (2 girls & 2 boys) who presented with tall stature during their childhood or adolescence and were evaluated in our hospital. Details regarding demographic information, clinical presentation, treatment history, laboratory investigations, and follow-up data including height velocity were collected after a review of their case records. Results: The first child presented at 4 years of age with a height SDS of +2.95; she was diagnosed to have congenital hypothyroidism at birth and previous height recordings did not have evidence of any accelerated growth spurt. As her bone age also corresponded to the increased height age, she was followed up with a provisional diagnosis of constitutional advancement of growth and puberty (CAGP). She entered puberty at the age of 7.5 years and attained menarche at the age of 9.5 years; her last recorded height at the age of 11 years was 161 cm, which is close to the target height of 163 cm. The second patient presented at 14 years of age with tall stature (SDS of +1.45, which was +1.70 above the conditional target height SDS). Her clinical examination revealed severe acanthosisnigricans with acromegaloid features and advanced bone age. Though all initial evaluation including GH dynamics were normal, she returned a year later with frank hyperglycemia and hypertriglyceridemia, and had no evidence of supra-normal growth velocity. The third patient was noticed to have transient acceleration in growth spurt (reported by his mother) with positive change in height SDS and bone age advancement when he presented with symptoms of hyperthyroidism. The growth acceleration settled with the treatment of Graves' disease. The fourth patient was an 18-year-old male who presented with tall stature (height SDS of +2.83) along with facial asymmetry and hypogonadism. He was diagnosed to have McCune Albright syndrome based on the clinical features and was found to have a GH-secreting macroadenoma that contributed to his tall stature. Conclusion: Tall stature is not typically considered a pathological condition and the majority of them require no intervention. However, a thorough physical examination and initial evaluation for bone age advancement and accelerated height velocity should always be done to ensure a pathological cause is not missed. We present a wide spectrum of etiological diagnoses ranging from CAGP to various endocrine disorders that can manifest as tall stature.