In the movie orphan how did Esther die?

In the movie "Orphan," Esther doesn't die. The ending reveals that she is actually a 33-year-old woman with a rare growth disorder that makes her appear to be a child.

The film ends with Esther killing her adoptive mother, Kate, and escaping the police. The implication is that she will continue her murderous ways, posing as a child and exploiting unsuspecting families.