Paediatrics: Constitutional delay in growth and puberty

Constitutional delay in growth and puberty

Relative short stature occurs because of a delay in the timing of onset of puberty. It is a variation in the timing of normal puberty, rather than an abnormal condition. It usually presents in early adolescence, although it may be recognized in earlier childhood. There is often a familial basis, of-ten having occurred in one of the parents. It is much commoner in males, although this may reflect a bias in the level of concern.

Characteristic features include short stature and delayed pubertal development by greater than 2 SDs. Typically, there is a mild degree of skeletal disproportion with evidence of a shorter back (sitting height per-centile) relative to leg length. There is invariably delay in BA maturation, which usually remains consistent over time. Height velocity is appropriate for BA.

Laboratory investigations are normal, including GH provocation tests.

Management

Usually no treatment is required as the onset of puberty and the accompa-nying growth spurt will occur spontaneously and an appropriate final adult target height is achieved.

Treatment is sometimes indicated in those adolescents who have dif-ficulty coping with their short stature or with the delayed physical devel-opment. Administration of sex steroids for a period of 3–6mths can be used to induce pubertal changes and to accelerate growth rate (boys: testosterone 50–100mg IM every 4wks).