From the Guidelines
Growth concerns in adolescent boys should be considered when a boy falls below the 3rd percentile on growth charts, shows a sudden decrease in growth velocity, or fails to enter puberty by age 14, as these signs may indicate underlying medical conditions requiring evaluation. According to the most recent evidence, a height velocity below the twenty-fifth percentile for age and sex indicates progressive growth failure in a child presenting with short stature 1. Other concerning signs include crossing two or more major percentile lines downward on growth charts, height significantly discordant with family patterns, or delayed puberty with no signs of development by age 14. Physical symptoms like chronic fatigue, persistent gastrointestinal issues, or joint pain alongside poor growth may also indicate underlying medical conditions requiring evaluation.
Some key points to consider when evaluating growth in adolescent boys include:
- A height velocity less than 1 cm per year in the presence of advanced clinical signs of puberty in adolescents may indicate near-adult height 1
- Boys who show growth but remain significantly shorter than peers, especially with a growth rate less than 2 inches per year during expected growth spurts, should also be evaluated
- Certain medical treatments, such as gonadotropin-releasing hormone analogues, may affect growth velocity and peak bone mass accrual 1
- Early identification of growth concerns allows for timely intervention, which is crucial since growth potential diminishes as bone growth plates close toward the end of puberty.
It is essential to consider these factors and evaluate growth concerns in adolescent boys to identify potential underlying medical conditions and provide timely intervention to optimize growth and development.
From the FDA Drug Label
Patients were enrolled on the basis of short stature, stimulated GH secretion > 10 ng/mL, and prepubertal status Baseline patient characteristics for the ISS patients who remained prepubertal at randomization (n= 105) were: mean (± SD): chronological age 11.4 (1.3) years, height SDS -2.4 (0.4), height velocity SDS -1.1 (0.8), and height velocity 4.4 (0.9) cm/yr
The FDA drug label does not answer the question of when to worry about growth in adolescent boys. The provided text discusses the treatment of growth failure in children with various conditions, including idiopathic short stature, but does not provide specific guidance on when to worry about growth in adolescent boys.
From the Research
Growth Patterns in Adolescent Boys
- Height that is less than the 3rd percentile or greater than the 97th percentile is deemed short or tall stature, respectively 2
- A growth velocity outside the 25th to 75th percentile range may be considered abnormal 2
- Serial height measurements over time documented on a growth chart are key in identifying abnormal growth 2
Identifying Growth Disorders
- Careful history and examination, and relevant targeted investigations, can streamline the referral process 3
- Causes of tall and short stature can often be distinguished on history, physical examination, and accurate pubertal staging 3
- Physiological variants remain the most common reason for short stature, but awareness of the features of pathological causes is critical 3
Considerations for Adolescent Boys
- Maturational delay in males is one of the most common presentations 3
- The height of the adolescent should always be considered in the context of their genetic potential 3
- There is limited research specifically focused on the use of certain treatments, such as aromatase inhibitors, in adolescent boys 4, 5, 6