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Kleinwuchs

Diagnostik und Therapie

Short stature

Diagnosis and treatment

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Zusammenfassung

Für einen Pädiater ist die Beurteilung von Wachstum und Körpergröße eines Kindes ein wichtiges Mittel, um die organische und die psychosoziale Gesundheit seiner Patienten einzuschätzen. Während definitionsgemäß eine Körpergröße < −2 SDS (SDS: „standard deviation score“) unterhalb des geschlechtsbezogenen Altersmittels das Vorliegen von Kleinwuchs bedeutet, stellt eine auffällig niedrige Wachstumsrate oft den frühen Hinweis auf eine zugrunde liegende pathologische Störung dar. Da die Liste der Ursachen für einen Kleinwuchs sehr lange ist, empfehlen sich bei der Diagnostik ein strukturiertes Vorgehen und die Unterteilung in Kleinwuchs aufgrund einer intrauterinen Wachstumsretardierung oder aber postnatalen Kleinwuchs mit normalen oder auffälligen Körperproportionen. Für einzelne Diagnosen kann eine Therapieindikation mit biosynthetischem humanem Wachstumshormon bestehen. Dies macht jedoch die leitliniengerechte Diagnostik und im Einzelfall auch die Abwägung zwischen dem erwarteten diagnosespezifischen Therapieerfolg und möglichen Risiken der Therapie notwendig.

Abstract

For a pediatrician the assessment of growth and body size of a child is an important means to assess the organic and psychosocial health. While by definition a body size <-2 standard deviation scores (SDS) below the gender and age-adjusted mean represents short stature, a low growth rate often represents an early indication of an underlying pathological disorder. As the list of the underlying causes of short stature is very long, a structured approach and the classification into diagnostic categories, such as short stature due to intrauterine growth retardation or postnatal short stature with normal or abnormal body proportions are recommended. For some diagnoses there may be indications for treatment with biosynthetic human growth hormone but this should follow a guideline-based decision-making process and in some cases an individual weighing up of the expected diagnosis-specific therapeutic success compared to potential risks of therapy is necessary.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Pfäffle hat Referentenhonorare der Firmen Ferring, Lilly, Sandoz, Merck-Serono, Novo-Nordisk und Pfizer erhalten und erhält ein Beraterhonorar der Fa. Sandoz. Wissenschaftliche Studien wurden und werden zu einem Teil durch Projektförderungen der Firmen Lilly, Pfizer und Novo-Nordisk unterstützt. Ein Interessenkonflikt besteht aus Sicht des Autors nicht. W. Kiess hat Referentenhonorare der Firmen Sandoz, Ipsen und Novo Nordisk erhalten, ein Beraterhonorar der Fa. Sandoz. Wissenschaftliche Studien wurden und werden zu einem Teil durch Projektförderungen der Firmen Pfizer, Novo Nordisk und Sandoz unterstützt. Ein Interessenkonflikt besteht aus Sicht des Autors nicht. J Kratzsch und R. Gausche geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Kinder und Jugendliche Leipzig, Liebigstr. 20a, 04103, Leipzig, Deutschland

    R. Pfäffle, W. Kiess, R. Gausche & J. Kratzsch

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  1. R. Pfäffle
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  2. W. Kiess
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  3. R. Gausche
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  4. J. Kratzsch
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Correspondence to R. Pfäffle.

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Pfäffle, R., Kiess, W., Gausche, R. et al. Kleinwuchs. Monatsschr Kinderheilkd 163, 723–744 (2015). https://doi.org/10.1007/s00112-015-3351-6

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  • DOI: https://doi.org/10.1007/s00112-015-3351-6

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