Constitutional Delay in Growth and Puberty

What is constitutional delay in growth and puberty?

Constitutional delay in growth and puberty is a condition in which children experience delayed puberty compared to their peers of similar age associated with a delay in the pubertal growth spurt (‘late bloomers’). These children have short stature relative to their parents’ heights, and a delayed bone age. The bone age is typically determined by examining the maturity of the individual’s bones relative to what is expected for their age in years since birth. These children typically have a family history of ‘late bloomers’. Once puberty begins, it progresses as expected, followed by the pubertal growth spurt. These children will typically have an adult height that is within range of what is expected for their genetic potential. 

The following conditions need to be considered and ruled out in making a diagnosis of constitutional delay in growth and puberty:

• Familial short stature: This is a condition in which the child is short because the parents are short. There is no pathological cause of short stature in the parents or the child
• Achondroplasia and other skeletal dysplasias: These are genetic conditions in which there are abnormalities in how bones develop and grow. These children usually have abnormal body proportions.
• Growth hormone deficiency (GHD): These children are short because their pituitary gland makes insufficient amounts of growth hormone (GH)
• Hypothyroidism: These children are deficient in thyroid hormone, another hormone that is very important for growth
• Cushing syndrome: In this condition, the adrenal glands make excessive amounts of cortisol (the hormone involved in the body’s response to stress), resulting in marked weight gain and a decrease in growth rate (in height), resulting in short stature
• Early onset of puberty: Going through puberty too early may result in short stature because the children have an early growth spurt and also stop growing early
• Nutritional disorders: In certain nutritional disorders, children are short because of associated inflammation and an inability to absorb nutrients appropriately
• Small for Gestational Age (SGA): Some infants who are smaller than average for gestational age at birth fail to demonstrate sufficient “catch-up” growth after birth, and remain short relative to their genetic potential
• Idiopathic short stature (ISS): This refers to children who are short relative to their genetic potential with no identifiable cause

What are the symptoms of constitutional delay in growth and puberty?

Here are the most common symptoms and signs of constitutional delay in growth and puberty:

• Normal growth rate but short stature
• Delayed puberty and the pubertal growth spurt with a delayed bone age (bones mature at a slower rate than expected)

How is constitutional delay in growth and puberty diagnosed?

Your healthcare provider will review your child’s health history, family history and physical exam, and may perform certain tests, including an x-ray of your child’s hand and wrist (bone age), to establish a diagnosis of constitutional delay in growth and puberty.

How is constitutional delay in growth and puberty treated?

Treatment of constitutional delay in growth and puberty depends on the child, and may include:

• Observation with careful monitoring of growth
• Attempting to “jumpstart” puberty by giving monthly testosterone injections for 4-6 months in boys

When should I call my healthcare provider?

Inform your healthcare provider if your child’s height is lower than expected based on the parents’ heights