Characteristic dynamics of height and weight in preschool boys with constitutional delay of growth and puberty or hypogonadotropic hypogonadism

Abstract

Objective Constitutional delay of growth and puberty (CDGP) is a frequent variant of the normal leading to short stature and/or pubertal delay. To distinguish CDGP from hypogonadotropic hypogonadism (HH), we evaluated height, growth and weight pattern of CDGP and HH in the first 5 years of life. Design and patients We studied retrospectively height and weight in the first 5 years (y) of life in 54 boys with CDGP and 8 boys with HH. Results In boys with CDGP, height‐SDS decreased (change −0.94 (interquartile range [IQR] −1.69 to −0.05); P < 0.001) between birth and 2 years. BMI‐SDS decreased (change −0.38 (IQR −1.21‐0.16); P < 0.001) in the same time period. There were no significant changes in height‐SDS or BMI‐SDS between 2 years and 5 years, while height‐SDS (change + 1.49 (IQR 1.02‐1.95); P < 0.001) and BMI‐SDS (change + 0.91 (IQR 0.12‐1.69); P < 0.001) increased between pubertal and adult age. In boys with HH, height‐SDS and BMI‐SDS did not change significantly in the first 5 years of life. Height‐SDS decreased (change −1.39 (IQR −1.96 to −0.67); P = 0.018) significantly between 5 years of life and puberty, while there were no significant changes in BMI‐SDS in this time period. At pubertal age, BMI‐SDS was significantly (P = 0.001) higher in boys with HH compared with boys with CDGP. Conclusion Height deflection and weight deflection in CDGP occur already during the first two years of life in contrast to HH. This different pattern of growth and weight might be helpful to distinguish CDGP from HH.

Clinical benefits of sex steroids given as a priming prior to GH provocative test or as a growth‐promoting therapy in peripubertal growth delays: Results of a retrospective study among ENDO‐ERN centres

“…Only one female from the whole cohort turned out to be affected by hypogonadotropic hypogonadism, thus ideally confirming the clinical impression that the great majority of children affected by true hypogonadotropic hypogonadism escape retardation of linear growth and do not present with short stature 36 …”

“…Only one female from the whole cohort turned out to be affected by hypogonadotropic hypogonadism, thus ideally confirming the clinical impression that the great majority of children affected by true hypogonadotropic hypogonadism escape retardation of linear growth and do not present with short stature. 36 In conclusion, in pre or peripubertal short subjects, priming with sex steroids prior to provocative testing for GH reserve seems to improve the diagnostic accuracy of provocative testing for GH reserve, potentially avoiding cumbersome and less effective rhGH treatment in children with a false-positive GHD diagnosis following an unprimed GHST. Indeed, we documented the highest degree of success, as well as the highest proportion of reconfirmed GHD at retesting after attainment of final height in GHD subjects diagnosed upon a primed GHST.…”

Adolescent boys with constitutional delay of growth and puberty grow faster than patients with organic growth hormone deficiency

“…Although there is some overlap, these data may reduce unnecessary testing and rhGH treatment of boys with CDGP (Figure 1). The recent description of the specific height and weight dynamics of boys with CDGP during their first 5 years of age may provide additional evidence 4 …”

“…They described a prepubertal deceleration in growth starting at an early age but plateauing after the age of 12 years 3 . Recently, we reported on the height and weight dynamics of boys with CDGP during the first five years of age based on longitudinal observations 4 and on the prediction of their adult height 5 . Reference data on height velocity of adolescents with CDGP are rare 3 or based on mathematical models, not on longitudinal or cross‐sectional height measurements 6,7 .…”

A Proposal for the Interpretation of Serum IGF-I Concentration as Part of Laboratory Screening in Children with Growth Failure

“…In children it is particularly difficult to distinguish IIGHD from the non-familial form of ISS with maturational delay (1,3,4). Many prepubertal short children who later present with delayed puberty, have a prepubertal growth pattern characterised by a low height velocity [decreasing height standard deviation score (SDS)] (13,14). However, the diagnosis of "Constitutional Delay of Growth and Puberty" can only be diagnosed with certainty if the onset of puberty (Tanner genital or breast stage 2) is indeed delayed (boys >14 years, girls >13 years).…”