PE30.7 | Endocrine Growth Deviation Referral — Summary & Reflection

KEY TAKEAWAYS

The core skill in this module is systematic rather than intuitive. A child with growth concern requires: accurate measurement on the correct chart, growth velocity calculation over ≥6 months, comparison against mid-parental height target (MPH ± 8.5 cm), bone age assessment when velocity is low or deviation is unexplained, and pattern interpretation against the differential (FSS, CDGP, GHD, hypothyroidism, Turner syndrome, chronic illness, FTT). The key referral triggers are growth velocity <4–5 cm/yr, centile crossing ≥2 lines, deviation below MPH target, or clinical features of an endocrine or systemic cause. Every girl with unexplained short stature needs a karyotype. Hypothyroidism is urgent because treatment is highly effective if started before growth plates close. FSS and CDGP require reassurance and serial monitoring, not investigation. The referral letter must include growth data, velocity, parental heights, pubertal staging, and any preliminary investigation results — the specialist cannot evaluate the child without this information.

REFLECT

Return to Priya from the opening case. You now know that her growth velocity is 3 cm/yr (115 cm at 9.5 yr → 118 cm at 10.5 yr), her MPH is (162 + 152 − 13)/2 = 150.5 cm with a target range of 142–159 cm, and she has a palpable, smooth goitre. Think about what you would do differently now compared to 30 minutes ago. Would you have reassured the parents without examining for goitre? Would you have missed the low growth velocity because her centile is only 'a little below normal'? What does her presentation tell you about the gap between how growth disorders present to a family ('she's just the shortest in class') versus how they present clinically ('she is hypothyroid and losing 3 years of growth velocity')? How will you ensure that every child in your future practice with a growth concern receives a structured assessment rather than an instinctive reassurance?