31The differences between FSS and CDGP are summarized in the table given
below.ParametersFamilial short
statureConstitutional delay in growth
and puberty
Midparental height Short Normal
Adrenarche Normal Delayed
Onset of puberty Normal Delayed
Bone age Normal Delayed
Correlation among CA, HA, BA CA=BA > HA CA > HA = BA
Final adult height Short Almost normal
CA chronological age, HA height age, BA bone age- What are the treatment options for children with idiopathic short stature?
Recombinant human growth hormone (rhGH) therapy is recommended in chil-
dren with ISS whose height is <−2.25 SDS and/or have a predicted adult height
<−2.0 SDS. The recommended dose of rhGH in children with ISS is 0.3–
0.375 mg/Kg/week, which is higher than the dose recommended in children
with GHD, as children with ISS are relatively GH resistant. Therapy with rhGH
results in a height gain of 3.5–7.5 cm, with mean duration of treatment of
4–7 years. Children with CDGP do not require therapy with rhGH as the final
adult height is normal in these individuals. Monotherapy with GnRH agonists
is not recommended in children with ISS. Combination therapy with GnRH
agonists and rhGH is a possible therapeutic option in these children; however,
there is insufficient data to routinely recommend the combination therapy.
Aromatase inhibitors, either alone or in combination with rhGH, have been
shown to increase predicted adult height in boys with ISS; however, data regard-
ing the final adult height with these agents is lacking. In addition, aromatase
inhibitors are not recommended in girls with ISS as there is limited data regard-
ing the use of these agents in girls.- What are the treatment options in children with CDGP?
The treatment options for boys with CDGP include oxandrolone, low-dose tes-
tosterone, or aromatase inhibitors, whereas in girls, low-dose estradiol is pre-
ferred. Oxandrolone (0.05–0.1 mg/Kg/day) is indicated in boys with CDGP
aged 10–14 years where short stature is a predominant concern and low-dose
testosterone (50–100 mg testosterone esters intramuscularly monthly for a
period of 3–6 months) after the age of 14 years where delayed puberty is of
significant concern. Although these therapies increase growth rate, final adult
height is not altered. Aromatase inhibitors alone and in combination with tes-
tosterone have been shown to increase predicted adult height in boys with
CDGP; however, data regarding the final adult height with these agents is lack-
ing. Low-dose estradiol is recommended in girls with CDGP, although there is
limited literature regarding its use.1 Disorders of Growth and Development: Clinical Perspectives