International Consensus on the Diagnosis and Clinical Management of Idiopathic Short Stature: A Modified Delphi Method
15 affiliations
- 1Paris Saclay University, AP-HP Endocrinology and Diabetes for Children, Bicêtre Paris-Saclay Hospital, le Kremlin-Bicêtre, France
- 2Department of Systems Medicine, University of Rome ‘Tor Vergata’, Rome, Italy
- 3Endocrinology and Diabetes Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- 4Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- 5Genetics and Genomic Medicine Research and Teaching Department, University College London, Great Ormond Street Hospital Institute of Child Health, London, UK
- 6Genetic Endocrinology Unit (LIM25), Endocrinology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
- 7The Institute of Pediatric Endocrinology, Diabetes & Metabolism, Dana-Dwek Children's Hospital, Tel Aviv, Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- 8Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 9Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- 10Pediatric Endocrinology Unit, IRCCS Istituto Giannina Gaslini Genoa, Italy
- 11University of Minnesota Medical School, Minneapolis, MN, USA
- 12Fujita Health University School of Medicine, Toyoake City, Japan
- 13Icahn School of Medicine at Mount Sinai, New York, NY, USA
- 14Discipline of Endocrinology, Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- 15Division of Endocrinology, Children’s National Hospital and Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
Abstract
Introduction: Idiopathic short stature (ISS) refers to children whose height falls substantially below the mean for sex and age relative to a reference population, despite the absence of an identifiable endocrine, genetic, syndromic, or systemic disorder. Clinical management remains challenging because no dedicated ICD-11 code exists and no universally accepted diagnostic criteria have been established. This has led to variability in how the condition is classified, inconsistency in access to testing, and uncertainty around eligibility for growth-promoting therapies. To address these inconsistencies and support broader global alignment in the recognition and management of ISS, an international consensus initiative was undertaken.
Methods: A Steering Committee of 10 internationally recognized experts with extensive clinical and academic expertise in ISS supported the development of a structured modified Delphi process. An Expert Panel of 22 key opinion leaders participated in a three-round survey conducted between November 2025 and February 2026. Panelists evaluated draft statements related to ISS definition, diagnostic criteria, burden of disease, and decision to treat. Consensus thresholds were predefined at 70%, and statements were refined between rounds, as needed.
Results: A total of 44 statements achieved consensus, with final agreement levels ranging from 77% to 100%. The statements establish a standardized clinical definition of ISS, propose evidence-based diagnostic criteria applicable across diverse healthcare settings, describe the impact of ISS on patients and caregivers, and suggest when to consider growth-promoting treatment for patients with ISS. For example, consensus was reached on the definition of ISS (a condition in which an individual has a height more than a standard deviation score of 2 below the mean for sex, age, and population, corresponding to below the 2.3 percentile, without identifiable underlying pathology) and on key elements of diagnostic evaluation (include the child's medical, developmental, and medication background, including prenatal and perinatal course, chronic illnesses or infections, and neurodevelopmental milestones, alongside family history and environmental exposures; perform a physical examination to identify clinical signs of underlying pathology, including assessment of body proportions, dysmorphic body features, head circumference, body mass index, and pubertal development). Key areas requiring future research were also highlighted.
Conclusion: This international consensus offers the first globally derived, ISS-focused guidance developed using a formal Delphi methodology for identifying and managing children and adolescents with ISS. Adoption of these recommendations may reduce regional variability, improve diagnostic clarity, and ultimately enhance outcomes for individuals affected by ISS.
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BibTeX
@article{linglart2026international,
title = {{International Consensus on the Diagnosis and Clinical Management of Idiopathic Short Stature: A Modified Delphi Method}},
author = {Agnès Linglart and Stefano Cianfarani and Mehul T. Dattani and Alexander A.L. Jorge and Yael Lebenthal and Xiaoping Luo and Mohamad Maghnie and Bradley S. Miller and Haruo Mizuno and Robert Rapaport and Paulo Ferrez Collett-Solberg and Andrew Dauber},
journal = {Hormone Research in Pædiatrics},
year = {2026},
month = aug,
doi = {10.1159/hrp/adaag008},
url = {https://doi.org/10.1159/hrp/adaag008},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - International Consensus on the Diagnosis and Clinical Management of Idiopathic Short Stature: A Modified Delphi Method
AU - Agnès Linglart
AU - Stefano Cianfarani
AU - Mehul T. Dattani
AU - Alexander A.L. Jorge
AU - Yael Lebenthal
AU - Xiaoping Luo
AU - Mohamad Maghnie
AU - Bradley S. Miller
AU - Haruo Mizuno
AU - Robert Rapaport
AU - Paulo Ferrez Collett-Solberg
AU - Andrew Dauber
PY - 2026
DA - 2026/08/27
JO - Hormone Research in Pædiatrics
DO - 10.1159/hrp/adaag008
UR - https://doi.org/10.1159/hrp/adaag008
AB - Introduction: Idiopathic short stature (ISS) refers to children whose height falls substantially below the mean for sex and age relative to a reference population, despite the absence of an identifiable endocrine, genetic, syndromic, or systemic disorder. Clinical management remains challenging because no dedicated ICD-11 code exists and no universally accepted diagnostic criteria have been established. This has led to variability in how the condition is classified, inconsistency in access to testing, and uncertainty around eligibility for growth-promoting therapies. To address these inconsistencies and support broader global alignment in the recognition and management of ISS, an international consensus initiative was undertaken. Methods: A Steering Committee of 10 internationally recognized experts with extensive clinical and academic expertise in ISS supported the development of a structured modified Delphi process. An Expert Panel of 22 key opinion leaders participated in a three-round survey conducted between November 2025 and February 2026. Panelists evaluated draft statements related to ISS definition, diagnostic criteria, burden of disease, and decision to treat. Consensus thresholds were predefined at 70%, and statements were refined between rounds, as needed. Results: A total of 44 statements achieved consensus, with final agreement levels ranging from 77% to 100%. The statements establish a standardized clinical definition of ISS, propose evidence-based diagnostic criteria applicable across diverse healthcare settings, describe the impact of ISS on patients and caregivers, and suggest when to consider growth-promoting treatment for patients with ISS. For example, consensus was reached on the definition of ISS (a condition in which an individual has a height more than a standard deviation score of 2 below the mean for sex, age, and population, corresponding to below the 2.3 percentile, without identifiable underlying pathology) and on key elements of diagnostic evaluation (include the child's medical, developmental, and medication background, including prenatal and perinatal course, chronic illnesses or infections, and neurodevelopmental milestones, alongside family history and environmental exposures; perform a physical examination to identify clinical signs of underlying pathology, including assessment of body proportions, dysmorphic body features, head circumference, body mass index, and pubertal development). Key areas requiring future research were also highlighted. Conclusion: This international consensus offers the first globally derived, ISS-focused guidance developed using a formal Delphi methodology for identifying and managing children and adolescents with ISS. Adoption of these recommendations may reduce regional variability, improve diagnostic clarity, and ultimately enhance outcomes for individuals affected by ISS.
SN - 1663-2818
SN - 1663-2826
ER -