Differential diagnosis of children with short stature not associated with metabolic, chromosomal, or gross nervous system defects.

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Abstract
Fifty-five children suffering from short stature but without known metabolic, chromosomal, or gross nervous system defects were classified as small normal children (21), low birthweight dwarfs (9), and hypo-somatotrophic dwarfs (25). The classification was made by reference to clinical criteria, growth progress over several years, and in some cases, a positive response to human growth hormone administration. On these criteria, small normals and hyposomatotrophic (or presumed growth hormone-lacking) dwarfs could best be diagnosed at initial interview by a height which was 3.5 standard deviations or more below the mean for the child''s chronological age, combined with a bone age on the Tanner-Whitehouse standards which was 65% or less of the chronological age. A subcutaneous insulin sensitivity test, if normal, tends to rule out the diagnosis of hyposomatotrophic dwarfism, but if positive was not very significant, in that a considerable number of small normal children appear to be sensitive. The response to ACTH was without value for distinguishing the 2 categories.

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