eMedicine Specialties > Pediatrics: General Medicine > Endocrinology
Constitutional Growth Delay: Follow-up
Updated: Aug 5, 2009
Follow-up
Further Outpatient Care
- Periodic evaluation of height, weight, and stage of sexual development should be performed in children and adolescents with constitutional growth delay (CGD). Plotting of growth parameters on standard growth charts, calculation of growth velocities, and documentation of Tanner stages for genital or breast and pubic hair development should be included.
- In addition to the above, adolescent males undergoing testosterone therapy should have an early morning testosterone level obtained a day or so before an injection is due when therapy may need to be discontinued. If the adolescent's endogenous testosterone level is 150 mg/dL or greater, therapy can be stopped and pubertal development can be expected to proceed normally.
Inpatient & Outpatient Medications
- Testosterone enanthate or cypionate (optional for males)
Complications
- Short-term complications of constitutional growth delay are primarily limited to psychosocial issues resulting from differences in stature and sexual development from peer groups. As infants, delay in bone age may also manifest as delays in motor skills and control of bowel or bladder function as a result of immature muscular development.
- Long-term consequences of constitutional growth delay are now recognized and may include height at the lower end of the reference range for an individual's family and osteopenia. The height deficit at the onset of puberty, shorter period between the onset of puberty and the adolescent growth spurt, and lower peak height velocity can contribute to a slightly lower adult height. Data on bone density are more conflicting. Osteopenia during adulthood is a concern because of the potential for reduced bone accrual during adolescence. Bone mineralization increases most in girls aged 11-14 years and in boys aged 14-17 years. More than half of adult bone calcium accumulates during this pubertal period. Delays in circulating sex steroids and resultant increases in growth hormone concentrations may lead to permanent deficiencies in bone mass. Some studies show that, although decreases in total bone that may be related to reduced limb bone mass and size may be present, volumetric density is normal.
Prognosis
- Most children with constitutional growth delay attain a normal adult height; however, stature tends to be at the lower end of the reference range for that individual's family because of the lower peak height velocity during the pubertal growth spurt. This observation may also reflect a bias in the individuals studied (more significantly delayed children referred to endocrinologists). Adult height is in contrast to individuals with idiopathic short stature (ISS), in whom stature and growth rate are likely to result in a low adult height (<61 in for males or <57 in for females).
- Predictions for adult height can be obtained through the use of tables designed to take into consideration current height and skeletal maturation. The Bayley-Pinneau tables are most commonly used to offer predictions for adult stature from a bone age in children aged 6-7 years and older. Different tables are available for normal, early, and late maturers because differences in the tempo of puberty and peak height velocity influence growth potential. Patients and parents should be aware that these predictions are estimates that become more accurate with advancing skeletal maturation.
Patient Education
- Education of patients and their families about normal growth patterns and the role of skeletal age as a predictor of onset and progression of puberty and ultimate height potential are important. Once patients realize that their growth pattern is not pathologic, anxiety is often ameliorated and they are less likely to perceive a need for pharmacologic intervention.
- For excellent patient education resources, visit eMedicine's Growth Hormone Deficiency Center. Also, see eMedicine's patient education articles Growth Failure in Children, Growth Hormone Deficiency, Understanding Growth Hormone Deficiency Medications, and Growth Hormone Deficiency FAQs.
More on Constitutional Growth Delay |
| Overview: Constitutional Growth Delay |
| Differential Diagnoses & Workup: Constitutional Growth Delay |
| Treatment & Medication: Constitutional Growth Delay |
 Follow-up: Constitutional Growth Delay |
| Multimedia: Constitutional Growth Delay |
| References |
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References
Sultan M, Afzal M, Qureshi SM, et al. Etiology of short stature in children. J Coll Physicians Surg Pak. Aug 2008;18(8):493-7. [Medline].
Banerjee I, Hanson D, Perveen R, Whatmore A, Black GC, Clayton PE. Constitutional delay of growth and puberty is not commonly associated with mutations in the acid labile subunit gene. Eur J Endocrinol. Apr 2008;158(4):473-7. [Medline].
Doneray H, Orbak Z. Association between bone turnover markers and bone mineral density in puberty and constitutional delay of growth and puberty. West Indian Med J. Jan 2008;57(1):33-9. [Medline].
[Best Evidence] [Guideline] Wilson TA, Rose SR, Cohen P, et al. Update of guidelines for the use of growth hormone in children: the Lawson Wilkins Pediatric Endocrinology Society Drug and Therapeutics Committee. J Pediatr. Oct 2003;143(4):415-21. [Medline].
Bierich JR. Constitutional delay of growth and adolescence. Baillieres Clin Endocrinol Metab. Jul 1992;6(3):573-88. [Medline].
Blethen SL, Gaines S, Weldon V. Comparison of predicted and adult heights in short boys: effect of androgen therapy. Pediatr Res. May 1984;18(5):467-9. [Medline].
Crowne EC, Shalet SM, Wallace WH, Eminson DM, Price DA. Final height in boys with untreated constitutional delay in growth and puberty. Arch Dis Child. Oct 1990;65(10):1109-12. [Medline].
Hagg U, Taranger J. Pubertal growth and maturity pattern in early and late maturers. A prospective longitudinal study of Swedish urban children. Swed Dent J. 1992;16(5):199-209. [Medline].
Horner JM, Thorsson AV, Hintz RL. Growth deceleration patterns in children with constitutional short stature: an aid to diagnosis. Pediatrics. Oct 1978;62(4):529-34. [Medline].
Krupa B, Miazgowski T. Bone mineral density and markers of bone turnover in boys with constitutional delay of growth and puberty. J Clin Endocrinol Metab. May 2005;90(5):2828-30. [Medline].
Leschek EW, Rose SR, Yanovski JA, et al. Effect of growth hormone treatment on adult height in peripubertal children with idiopathic short stature: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab. Jul 2004;89(7):3140-8. [Medline].
Miller BS, Zimmerman D. Idiopathic short stature in children. Pediatr Ann. Mar 2004;33(3):177-81. [Medline].
Poyrazoglu S, Gunoz H, Darendeliler F, Saka N, Bundak R, Bas F. Constitutional delay of growth and puberty: from presentation to final height. J Pediatr Endocrinol Metab. Feb 2005;18(2):171-9. [Medline].
Racine MS, Symons KV, Foster CM, Barkan AL. Augmentation of growth hormone secretion after testosterone treatment in boys with constitutional delay of growth and adolescence: evidence against an increase in hypothalamic secretion of growth hormone-releasing hormone. J Clin Endocrinol Metab. Jul 2004;89(7):3326-31. [Medline]. [Full Text].
Ranke MB, Aronson AS. Adult height in children with constitutional short stature. Acta Paediatr Scand Suppl. 1989;362:27-31. [Medline].
Rosenfeld RG, Northcraft GB, Hintz RL. A prospective, randomized study of testosterone treatment of constitutional delay of growth and development in male adolescents. Pediatrics. Jun 1982;69(6):681-7. [Medline].
Yap F, Hogler W, Briody J, et al. The skeletal phenotype of men with previous constitutional delay of puberty. J Clin Endocrinol Metab. Sep 2004;89(9):4306-11. [Medline]. [Full Text].
Zachmann M, Studer S, Prader A. Short-term testosterone treatment at bone age of 12 to 13 years does not reduce adult height in boys with constitutional delay of growth and adolescence. Helv Paediatr Acta. Jun 1987;42(1):21-8. [Medline].
Further Reading
Keywords
constitutional growth delay, CGD, delayed puberty, physiologic hypogonadotropic hypogonadism, short stature, idiopathic short stature, ISS, delayed sexual development, physiologic hypogonadotropic hypogonadism, gonadal dysfunction, growth retardation, delayed puberty, diagnosis, treatment
