Reassurance of the family and the patients is the key to the management of normal-variant tall stature.The use of the bone age to predict adult height may provide some comfort, as will general supportive discussions on the social acceptability of this condition.

While treatment is available for girls and boys with excessive growth, its use should be restricted to patients with

(1) predicted adult height >3 SD above the mean (78 inches in males, 71 inches in females) and

(2) evidence of significant psychosocial impairment.

For the family that feels strongly about treatment, a trial of sex steroids may be considered. Such therapy is designed to accelerate puberty and epiphyseal fusion and is therefore of little benefit when given in late puberty; therapy is initiated ideally prepubertally or in early puberty.

In boys, treatment should begin before the bone age reaches 14 yr; testosterone enanthate is used at a dose of 500 mg IM every 2 wk for 6 mo.

In females, oral estrogens in various doses have successfully reduced the predicted height by 5–10 cm on average. This is a direct result of the known effects of sex steroids on promoting epiphyseal fusion; therapy must begin, therefore, before the bone age has reached 12 yr. Oral ethinyl estradiol at a dose of 0.15–0.5 mg/day until cessation of growth occurs has been used successfully in girls. If necessary, a progestational agent can be added after 1 yr of unopposed estrogen.

The lack of extensive experience with this form of therapy and the risks involved should be carefully weighed and discussed with the family before embarking on therapy.

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