de Muinck Keizer-Schrama S M
Sophia Kinderziekenhuis, afd. Kindergeneeskunde/Endocrinologie, Rotterdam.
Ned Tijdschr Geneeskd. 1998 Nov 14;142(46):2519-25.
Each year about 2500 children in the Netherlands are referred to a specialist because of short stature. Aim of the consensus meeting: 'Diagnosis of short stature in childhood' by general practitioners, pediatricians and pediatric endocrinologists was to promote early diagnosis and treatment of aberrant growth but also to prevent unnecessary referral and interventions. For optimal treatment of growth disorders early diagnosis is of the utmost importance. Short stature is best detected by the use of standard deviation scores (SDS) instead of percentile lines. As cut-off point for referral SDS < -1.3 (< P10) was chosen in order to identify risk groups that need further evaluation. Based on international consensus a diagnostic classification of short stature is possible, distinguishing normal variants and (or) idiopathic short stature from primary and secondary growth disorders. Using target length, the growth curve in the SDS diagram, the actual age and puberty signs, the general practitioner can use a flow chart to determine whether there is a growth problem and whether this needs treatment in primary or secondary health care. Measuring skeletal age has no additional value. Attention should also be given to psychosocial problems as the cause or the effect of short stature.
在荷兰，每年约有2500名儿童因身材矮小被转诊至专科医生处。全科医生、儿科医生和儿科内分泌学家召开的“儿童身材矮小的诊断”共识会议的目的是促进对异常生长的早期诊断和治疗，同时防止不必要的转诊和干预。对于生长障碍的最佳治疗而言，早期诊断至关重要。使用标准差评分（SDS）而非百分位数线能更好地检测身材矮小。为了确定需要进一步评估的风险群体，选择SDS < -1.3（< P10）作为转诊的临界点。基于国际共识，对身材矮小进行诊断分类是可行的，可区分正常变异和（或）特发性身材矮小与原发性和继发性生长障碍。通过使用目标身高、SDS图表中的生长曲线、实际年龄和青春期体征，全科医生可以使用流程图来确定是否存在生长问题以及这是否需要在初级或二级医疗保健中进行治疗。测量骨龄并无额外价值。还应关注作为身材矮小原因或结果的心理社会问题。
