Tall stature or large stature (macrosomia) can be a familial variant, but also a serious disease. Tumors or various hereditary factors are the cause. Medical help is recommended in any case of tall stature.
What is high growth?
High growth is defined by medical experts based on a body length that is above the 97th percentile. This means a person is among the 3% tallest of his or her gender peers in the same age group. A common classification divides the phenomenon of tall stature into two groups: Macrosomia (tall stature), which by definition is present when the body length exceeds 1.92 m for men and 1.80 m for women. Gigantism (giant stature) is when men are over 2.00 m tall and women are over 1.85 m tall. This definition does not initially consider the underlying causes. Doctors speak of primordial tall stature when the height is genetically determined and not pathological and does not result in any complications. If the causes are based on disease processes, growth disturbances occur that result in disabilities. Hereditary diseases and hormonal disorders are the causes present in the context of gigantism in tall stature.
Causes
Tall stature in the pathological expression often results from hormonal imbalance. In most cases, disorders in the pituitary gland (hypophysis) during the growth phase are responsible. Benign tumors are the ones that disrupt the production of growth hormones in the central endocrine gland. Tumors can occur in the pancreas (pancreas), the tissue of which produces a growth hormone. This shifts the endocrine (hormonal) balance. Hyperthyroidism (overactive thyroid gland) in the newborn also poses the risk of hormone-induced hypergrowth. Finally, hormonal factors include maternal diabetes occurring during pregnancy (gestational diabetes). Furthermore, chromosomal genetic defects such as Marfan syndrome and Sotos syndrome have been described as triggers for tall stature. In Klinefelter syndrome, a supernumerary X chromosome (sex chromosome) is present in males (chromosomal aberration) and causes pathological tall stature.
Symptoms, complaints, and signs
Tall stature can be clearly diagnosed by its characteristic symptoms. The condition is primarily recognized by the above-average height of affected individuals. In most cases, affected children experience severe growing pains. Intense pain in the bones, joints and muscles occurs especially during puberty. High growth can also trigger extreme growth spurts, causing joint and bone disorders. In the course of the disease, other complaints may occur, such as inflammation, circulatory disorders or poor posture. In the long term, tall stature patients develop health problems such as back pain, postural defects and, in individual cases, nerve damage. Depending on the underlying cause of the high growth, neurological complaints may also occur. If a tumor disease is the cause, corresponding symptoms occur, i.e. neurological disorders, visual disturbances, pain attacks and an increasing feeling of illness. If the high growth is caused by a hormone disorder, severe malaise also occurs, often accompanied by complaints of the immune system and the psyche. Hyperthyroidism can cause gastrointestinal complaints, skin changes and a variety of other accompanying symptoms. The main symptom of hyperthyroidism, i.e. enormous height, cannot be reversed by treatment. Any accompanying symptoms usually subside completely after the growth spurt.
Diagnosis and course
Tall growths should be examined by a physician if growth spurts are noticeable. He or she can determine whether it is a disease process or whether there is a simple underlying normogenetic predisposition. The blood laboratory values provide information about the hormone status, which requires radiological diagnostics in case of deviations. If necessary, magnetic resonance imaging may also be used. The course of pathological tall growth varies greatly depending on its form and therapeutic options. Hormone-induced gigantism leads to imbalanced bone growth. This results in sometimes serious orthopedic clinical pictures. This can be pronounced as partial gigantism and affect only body part regions.In premature sexual maturity (pubertas praecox), secondary sexual characteristics develop in high growth at the age of less than 10 years.
Complications
High growth does not necessarily lead to complications or symptoms in every case. In some cases, it is genetic and for this reason does not need to be treated by a doctor. In children, the tall growth causes growth disturbances that may be accompanied by pain. It is not uncommon for children to be bullied or teased because of their tall stature, which can lead to psychological discomfort. Likewise, the tall stature can lead to uneven growth of the bones, resulting in deformities or restricted movement. Furthermore, there is usually premature development of the sexual organs. The treatment of this disease always depends on the cause and is causal. As a rule, no further complications occur. In the case of a tumor, it can be removed, and radiation therapy is usually used. Therapy with hormones is also possible in order to counteract and stop the growth. Not infrequently, those affected also require therapy with an orthopedist and also with a psychologist. In this way, consequential damages in adulthood can be avoided. Life expectancy is not reduced by the tall growth.
When should one go to the doctor?
If the child complains of severe pain during growth, a visit to the doctor is recommended. Often there are natural causes underlying the tall growth, but occasionally a disease is causative, which must be clarified and treated. Parents who notice such signs in their child should therefore consult a doctor. This is especially true if there is a suspicion of a serious underlying disease. For example, unusual pressure pain or changes in personality should be clarified quickly. There may be a tumor or a hormonal disorder that requires therapeutic treatment. Infants who have been diagnosed with hyperthyroidism are particularly susceptible to hormone-induced tall stature. Parents of affected children should consult with their pediatrician regularly and arrange for an examination if any unusual symptoms are observed. If there are cases of chromosomal genetic defects in the family, the child should be examined promptly after birth. In the case of inheritance, further treatment steps must be initiated to counteract the tall stature and other accompanying symptoms of the syndrome in question.
Treatment and therapy
Treating tall stature requires intervention during the growth phase. If there is an underlying tumor, surgical intervention may be possible in some cases. However, such surgery on the pituitary gland is very risky. Since they are usually not malignant (malignant) tumors, surgery is often not absolutely necessary. Alternatively, there is the possibility of radiation or chemotherapy. In order to avert growth disturbance, the doctor can arrange hormone therapy. Estrogens and progestins are female hormones that are used accordingly in girls. In boys, on the other hand, the male hormone testosterone causes a premature end to length growth. If the doctor diagnoses gestational diabetes in the expectant mother, the temporary diabetes must be optimally adjusted. In this way, the physician can counteract excessive growth of the foetus. If medical intervention occurs too late in the course of adolescence, only later treatment of the symptoms in the adult remains. Especially in cases of gigantism, the orthopedist is called upon to treat the sequelae of unbalanced bone growth. The genetically caused variants of gigantism often require speech therapy because speech development is delayed. In the case of Marfan syndrome, any additional cardiovascular diseases must be treated. A broad spectrum of symptoms is overall characteristic of tall stature.
Outlook and prognosis
The prognosis of tall stature depends on the presenting cause and the timing of treatment. If the patient is already full-grown, no reduction in height can be achieved. Affected individuals have lifelong tall stature and may receive psychotherapy for better management of physical size. The body does not begin to minimize its height by a few centimeters until high adulthood due to its natural progression.In most cases, tall stature is triggered by a genetic disposition or hormonal disorder. Since an intervention in the genetics of humans is not permitted with today’s legal conditions, no modification of the genetic material can take place. However, in the case of a familial high growth, a genetic test can be performed on the offspring at an early stage and, if desired, treatment can be initiated during the growth and development process. If there is a disorder of the hormonal system, the prognosis is usually optimistic. By administering appropriate hormonal preparations during the growth phase of the body, a dampening of growth can be achieved. In many patients, it is not so much the physical abnormality that is problematic. Rather, there are emotional or psychological problems due to the optical blemish. In individual cases, it should therefore be examined whether psychotherapeutic treatment is sufficient to prevent the high growth from being mentally classified as a disease.
Prevention
Preventing tall stature is difficult. Only in the case of gestational diabetes can preventive success be achieved by controlling the blood glucose of the expectant mother. In adolescents, early detection of the syndrome is crucial for any therapeutic success in high growth.
Follow-up
In most cases of high growth, either very little or no aftercare measures are available to the affected individual. In this case, the disease can also not be treated, since it is usually a genetic disease. However, the earlier a doctor is contacted, the better the further course of the disease, as this can prevent further complications or complaints. The parents of the affected child should therefore consult a doctor at the first signs and symptoms of the disease. If the affected person wishes to have a child, genetic counseling or testing can also be performed to prevent the recurrence of the disease. In many cases, those affected suffer from psychological upsets or depression. To alleviate these, intensive discussions with parents or friends are usually necessary. However, if the tall growth is caused by a tumor, it must be surgically removed. The further course of the disease depends strongly on the time of diagnosis, so that no general prediction can be made. Possibly the life expectancy of the patient is also reduced by the tall growth.
What you can do yourself
If the growth is not yet completed, today’s medicine offers the treatment option of artificially gradually induced synostosis of the epiphyseal joints of the long bones, which leads to slower subsequent growth. In girls this is done by therapy of estrogens and, if necessary, additionally of gestagens. In boys, the therapy starts with testosterone. To strengthen the back muscles, which are often vulnerable in people with pronounced tall stature, physiotherapy can be used. If the cause of the high growth is a genetic disorder, speech development and motor skills are often impaired. These symptoms can be addressed by a speech therapist or occupational therapy. People affected by high growth can help themselves in self-help groups. There they can exchange ideas with “fellow sufferers”, encourage each other and look for common solutions to everyday problems. For a fulfilled life and for an increase in self-esteem, there are also activities in which size can be perceived as an advantage rather than a problem, as is the case with volleyball or basketball, for example. Increasing self-esteem is thus also possible for those affected by tallness through active self-help, which is also important because those affected have been exposed to multiple experiences of bullying and stigmatization.