eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Constitutional Growth Delay: Treatment & Medication

Author: Pamela A Clark, MD, Consulting Staff, McLeod Physician Associates; Consulting Staff, McLeod Pediatric Subspecialties
Contributor Information and Disclosures

Updated: Aug 5, 2009

Treatment

Medical Care

Medical care in constitutional growth delay (CGD) is aimed at obtaining several careful growth measurements at frequent intervals, often every 6 months. These measurements are used to calculate linear height velocities and establish a trajectory on the growth curve. Medical treatment of this variation of normal growth is not necessary but may be initiated in adolescents experiencing psychosocial distress (see Medication).

Diet

No special dietary requirements are necessary, although a balanced diet with adequate calories and calcium intake is recommended to support normal growth and bone development.

Activity

No restrictions on activity are necessary. However, adolescents with constitutional growth delay who participate in contact sports must realize their limitations in competition with larger, stronger peers. Adolescents who wish to participate in weight lifting or resistance-training activities should use lower weights with greater repetitions to avoid undue stress on immature growth plates.

Medication

Because constitutional growth delay (CGD) is not a disorder but rather a variation of normal growth, medical treatment is not necessary. However, short courses of sex hormones are an option for those patients experiencing psychological distress because of their delay in growth and development. In males, androgens can be used to accelerate linear growth and onset of pubertal changes. When used appropriately, no detrimental effects on adult height are evident. Therapy does not increase adult stature. Guidelines have been established for children in whom growth hormone (GH) therapy is indicated.4

Anabolic steroids

These agents promote growth and sexual maturation.


Testosterone (Delatestryl, Depo-Testosterone)

Depot preparation of testosterone available as enanthate or cypionate salt. Available in multiuse vial for IM injection. Transdermal preparations are available and have been used successfully in this context, although no established protocols are available.

Adult

300 mg IM q2-3wk is adult replacement dose

Pediatric

50-100 mg IM qmo starting dose; dose can be increased by 50 mg q3-4mo; total duration of therapy 6-18 mo; discontinue when endogenous testosterone production evident (when early-morning testosterone level >150 mg/dL is determined right before an injection would be due)

Documented hypersensitivity; severe renal, hepatic, or cardiac disease; hypercalcemia; pregnancy; boys with a skeletal age <11.5-12 y (potential lessening of adult height because of more rapid skeletal maturation rather than acceleration in height)

Pregnancy

X - Contraindicated in pregnancy

Precautions

Advance dose slowly; do not administer more frequently than monthly to minimize suppression of hypothalamic-pituitary-gonadal axis; anabolic effects may alter serum glucose; not for IV administration; use of oral preparations of testosterone are not appropriate because they have been associated with hepatic toxicity

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

  1. 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].

  2. 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].

  3. 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].

  4. [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].

  5. Bierich JR. Constitutional delay of growth and adolescence. Baillieres Clin Endocrinol Metab. Jul 1992;6(3):573-88. [Medline].

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. Miller BS, Zimmerman D. Idiopathic short stature in children. Pediatr Ann. Mar 2004;33(3):177-81. [Medline].

  13. 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].

  14. 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].

  15. Ranke MB, Aronson AS. Adult height in children with constitutional short stature. Acta Paediatr Scand Suppl. 1989;362:27-31. [Medline].

  16. 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].

  17. 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].

  18. 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].

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Further Reading

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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

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Contributor Information and Disclosures

Author

Pamela A Clark, MD, Consulting Staff, McLeod Physician Associates; Consulting Staff, McLeod Pediatric Subspecialties
Pamela A Clark, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Arlan L Rosenbloom, MD, Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology
Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Florida Pediatric Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Barry B Bercu, MD, Professor, Departments of Pediatrics, Molecular Pharmacology and Physiology, University of South Florida College of Medicine, All Children's Hospital
Barry B Bercu, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Federation for Clinical Research, American Medical Association, American Pediatric Society, Association of Clinical Scientists, Endocrine Society, Florida Medical Association, Lawson-Wilkins Pediatric Endocrine Society, Pituitary Society, Society for Pediatric Research, Society for the Study of Reproduction, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfizer, Inc. Honoraria Consulting

 
 
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