In adults, the ratio is often reduced (ie, < 1 in whites, < 0.9 in blacks) as a result of the longer period of leg (long bone) growth 7). During childhood, the upper-to-lower body ratio may be greater than normal, reflecting more infantile proportions. Body proportions may reflect the delay in growth. Physical examination findings in patients with constitutional growth delay are essentially normal, with the exception of immature appearance for age. It is not until puberty when one will notice that the child starts to divert from the curve, usually because they have late onset of puberty that corresponds to a delay bone age 6). After four years of age, there is constant steady growth. This tendency will typically resume to a standard rate after this period. Between 3 to 6 months to 2 to 3 years of age, the expectation is that some children will cross percentiles in their growth and weight charts without actual concerns for a delay in growth. It’s important to remember that growth velocity varies accordingly. Ĭonstitutional growth delay is seen in approximately 15% of children and can appear at different stages of their development. Studies have suggested that referral bias is largely responsible for the impression that normal short stature per se is a cause of psychosocial problems nonreferred children with short stature do not differ from those with more normal stature in school performance or socialization 5). The mean final or near-final height reached by the subjects was 165.7 cm, compared with a predicted adult height of 170.7 cm and a target height of 171.8 cm.Īlthough constitutional growth delay is a variant of normal growth rather than a disorder, delays in growth and sexual development may contribute to psychological difficulties, warranting treatment for some individuals. However, a report by Rohani et al 4) on males with constitutional growth delay-mean age 15.2 years at presentation and 20 years at study’s end-found that the majority of patients attained neither their target height nor their predicted adult height. Catch-up growth, onset of puberty and pubertal growth spurt occur later than average, resulting in normal adult stature and sexual development. Īt the expected time of puberty, the height of children with constitutional growth delay begins to drift further from the growth curve because of delay in the onset of the pubertal growth spurt. Constitutional growth delay is twice as common in boys compared to girls although some of the male referrals may be just concerns regarding their height compared to their peers rather than an actual delay 3). Įstimates are that about 15% of patients referred to a specialist due to short stature have constitutional growth delay. At that time, growth resumes at a normal rate, and these children grow either along the lower growth percentiles or beneath the curve but parallel to it for the remainder of the prepubertal years 2). In constitutional delay of growth and puberty (in which statural growth falls below 5% of the growth curve after 1–2 years of age and is further delayed due to late start to puberty), linear growth velocity and weight gain slows beginning as young as age 3-6 months, resulting in downward crossing of growth percentiles, which often continues until age 2-3 years. Children with constitutional delay of growth and puberty, the most common cause of short stature and delayed puberty, typically have retarded linear growth within the first 3 years of life 1). Constitutional growth delay complicationsĬonstitutional growth delay also called constitutional delay of growth and puberty, is a variant of normal growth rather than a disorder.Constitutional growth delay differential diagnosis.Constitutional growth delay inheritance pattern.Patients with an organic cause for delay are given sex-steroid therapy to induce puberty and are most likely to require lifelong hormone replacement therapy after puberty is complete. Sex-steroid treatment is reserved for those with psychosocial maladaptation, and consists of a short course of sex steroids to induce puberty. Patients with constitutional delay are typically observed. The distinction between organic gonadotrophin deficiency and constitutional delay of puberty is not easy and is often resolved only with time. Most patients seek medical assistance because of slow growth rather than slow pubertal development.Ĭareful assessment of height and pubertal stage is crucial for evaluation of the underlying cause. May be functional (constitutional delay, underlying chronic disease, malnutrition, excessive exercise) or organic, due to either a lack of serum gonadotrophin production or action (hypogonadotrophic hypogonadism), or gonadal insufficiency with elevated gonadotrophins (hypergonadotrophic hypogonadism). Defined as the lack of any pubertal signs by the age of 13 years in girls and 14 years in boys.
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