From the Guidelines
The patient is experiencing constitutional growth delay, which is a common cause of short stature in adolescents, and the recommended approach is reassurance and watchful waiting, as this condition typically resolves with time, with no medical intervention needed at this time, as supported by the most recent study 1. This diagnosis is supported by his delayed bone age (10 years vs. chronological age of 13), Tanner stage 1 (pre-pubertal), and height below what would be expected based on his parents' heights. The patient will likely experience delayed puberty but should eventually reach a normal adult height consistent with his genetic potential. Some key points to consider in the evaluation of short stature include:
- Differentiating between isolated short stature and short stature associated with other physical and/or developmental abnormalities, as outlined in the study 1
- Determining whether the short stature is proportionate or disproportionate, as discussed in the study 1
- Considering potential diagnoses such as familial short stature, constitutional delay of growth, occult pulmonary, renal or gastrointestinal disease, endocrinopathies, and genetic disorders, as mentioned in the study 1
- Monitoring growth velocity and pubertal development, as recommended in the study 1
- Providing nutritional counseling to address picky eating habits and ensure adequate intake of protein, calcium, and other nutrients essential for growth, as suggested in the study 1 The patient and family should be reassured that while he is currently behind his peers in growth and development, he will likely have a later growth spurt and catch up to his expected adult height. Constitutional growth delay is a normal variant of growth, not a pathological condition, and the delayed bone age suggests he has more growth potential remaining than his chronological age would suggest, as supported by the study 1. Follow-up visits every 6-12 months to monitor growth velocity and pubertal development are recommended, as outlined in the study 1.
From the Research
Patient's Condition
- The patient is a 13-year-old boy who is concerned about being the shortest boy in his class.
- He has a height of 140 cm (55 in) and weight of 39 kg (86 lb), with a bone age of 10 years.
- His sexual maturity rating (Tanner stage) is 1, indicating delayed puberty.
- The patient's diet consists primarily of cereal, fruit, pasta, and pizza, and he takes a daily multivitamin.
Possible Causes of Short Stature
- Growth hormone deficiency: A study published in 2011 2 found that Klinefelter syndrome can be associated with short stature due to growth hormone deficiency.
- Delayed bone age: Research suggests that delayed bone age may impact the response to growth hormone treatment in children with short stature 3, 4.
- Constitutional delay of growth and puberty: This condition is characterized by short stature, delayed puberty, and delayed bone age, and is a common condition in pediatric endocrine clinics 5.
Diagnostic Considerations
- Bone age assessment: The use of bone age in clinical practice can help diagnose and manage children with short stature 4.
- Growth hormone stimulation tests: These tests can help confirm growth hormone deficiency and guide treatment decisions 6.
Treatment Options
- Growth hormone replacement therapy: This treatment can help improve growth and psychosocial problems in children with short stature due to growth hormone deficiency 3, 6.
- Induction of puberty: In cases of constitutional delay of growth and puberty, treatment with androgens may be considered to induce secondary sex characteristics and improve final height outcomes 5.