Constitutional Delay of Growth and Puberty: From Presentation to Final Height

Abstract

This retrospective study evaluated clinical characteristics of patients with constitutional delay of growth and puberty (CDGP) at presentation, during puberty and at final height. The records of 151 children (105 boys, 46 girls) with CDGP were reviewed and the results were evaluated with respect to findings in healthy Turkish schoolchildren. CDGP was twice as frequent in boys as in girls. Height and weight deficit and short sitting height of the children were evident at presentation and continued up to final height. Mean age of onset of puberty was retarded by 2.5 years in girls and by 3 years in boys. The time between onset of puberty and pubertal growth spurt was shorter in both girls and boys than in the controls. Peak growth velocity was compromised in both girls and boys. Forty-one patients (30 boys, 11 girls) reached final height (FH). Mean FH was shorter than both target height and predicted adult height. The Bayley-Pinneau method was found to be a better predictor of FH than either the Tanner-Whitehouse method or target height. FH also showed correlation with the father's height. There was no effect of testosterone treatment on final height. Height deficit at onset of puberty, shorter duration between onset of puberty and pubertal growth spurt, compromised peak growth velocity and short upper segment due to delayed puberty, are findings which may explain the decreased final height of children with CDGP.

A New Model of Adult Height Prediction Validated in Boys with Constitutional Delay of Growth and Puberty

“…CDGP constitutes a fairly large group of patients seen in pediatric clinics [11, 14-16] with boys presenting much more frequently than girls [9, 11, 14, 17]. No indices for adult height prediction are available for boys with retarded bone ages >13 years in the BP method [2].…”

Adult Height in Girls with Delayed Pubertal Growth

“…In 1993, Albanese and Stanhope [10] investigated 34 girls, in whom adult stature was as much as 1.5 SDS below TH. Of 46 girls studied by Poyrazoglu et al [28] in 2005, 76% did not reach their parental TH range. These numbers are in accordance with our results.…”

“…In contrast, only a few studies have reported AH in girls with this condition [1,7,10,28], probably because of the paucity of girls with CDGP seen in clinical practice. Although AH in girls with CDGP has been stated to be within a normal range of the general population [7], it may remain below the genetic target [1,10,28]. In the study by Crowne et al [1] in 1991, AH in 23 female CDGP subjects was 0.7 SDS below their TH [1].…”

The Effect of Clonidine Therapy on Height and Growth Velocity in Constitutional Growth and Puberty Delay

“…The diagnosis of CGDP was defined as [10] height below the third percentile or > 2 standard deviation (SD) below that of children of the same chronological age and sex, according to center for disease control (CDC) clinical growth charts based reference, delayed bone age (by ≥ 2 years), low growth rates < 5 cm/y, GH response of > 10 µg/L to at least two stimulation tests (clonidine and exerciseinduced) in otherwise healthy prepubertal boys. Systemic or specific causes of short stature were ruled out by history, physical examination and routine laboratory tests.…”

“…The use of clonidine in children with CGDP has been the subject of several studies [8,9] but, very divergent results have been reported and therefore the effectiveness of clonidine in increasing growth rate of CGDP is not clear. Many subjects affected by constitutional short stature show a good response to human growth hormone (HGH) therapy, whereas others do not benefit by this treatment [10][11][12][13]. The use of aromatase inhibitors and oxandrolone, a weak anabolic steroid has been shown to be effective in children with CGDP.…”