Chapter 3 Index

A. General

B. Skin

C. Orthopedics

D. Genitourinary

E. Endocrine

15-Year Old Boy with Short Stature, Delayed Puberty

Case History: A 15-year 8-month old boy comes into your office; he complains that he is tired of being the shortest boy in his class, and wants you to do something about it.  On physical exam he is staged at Tanner 1.  What tests or information would you like?

Growth Chart: Patterns of Growth Can Determine Diagnosis: Differential dx Should Include:

• Constitutional delay: growth chart shows that height was normal in first few years, then stays at same distance below 5th %ile.

• Genetic short stature: always below the 5th %ile
• Emotional deprivation: depends on time of effects: can be early, can be late
• Short stature associated with illness: falloff of curve dates to time of beginning of illness such as inflammatory bowel disease, renal disease
• Endocrine problems: usually short stature present at birth; can be SGA as well; examples include chromosomal conditions (Turner’s, Noonan’s, Down – see Smith’s textbook)
• Pituitary problems such as GH deficiency, hypopituitarism.  Growth can be normal in the first year to year and a half
• Eating disorders: growth pattern normal until onset of disorder.

Workup:Based on the Growth Chart Pattern, History and Physical Examination:

History: should include family history; review of growth chart:

Physical Examination: determine Tanner Stage; evidence of wasting, abnormalities

Laboratory tests: X-Rays: bone age of wrist; Blood work: ESR; BMP; consider T4, TSH, IGF-1 (insulin-like growth factor), serum testosterone 

Results of Workup of Child Presented Above: Child grew normally until 3 years of age, has grown 5 cm a year since age 5 years but has been below 5th%ile since that time. His father, now 5 ft 10 inches tall, had a late growth spurt.  His older brother is of normal stature.  Laboratory: Bone age: 11 years 8 months. Diagnosis: constitutional short stature.

Cause of Constitutional Growth Delay:  Persistence of the relative hypogonadotropic state of childhood.

Treatment: Should Growth Hormone or Testosterone Be Used?

Growth Hormone: Early evidence that synthetic GH might stimulate growth in children with normal GH levels.  Recent evidence that long-term no advantage.  This treatment is extremely expensive, requires 3-5 shots/week and is no longer recommended for the usual patient with short stature.  Possible indication for using synthetic GH in normal children: psychological problems.

Testosterone: Effective and indicated in certain situations.  Essentially it initiates puberty, but ultimately might not make major difference.  No negative effects on bone age. Treatment with 100-200 mg IM once a month for 4 months; rarely second course needed.

Next Page

© Medical College of Georgia
All rights reserved.

Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004