Eleanor Finch
Constitutional delay in growth and puberty (CDGP) is a condition in which children experience a delay in puberty and the pubertal growth spurt compared to their peers of a similar age. It is associated with a delay in bone age and a short stature relative to their parents' heights. CDGP is the most common cause of delayed puberty, affecting over 2% of adolescents, mainly boys. While it is considered a variant of normal growth rather than a disease, the associated short stature and delayed sexual development can lead to psychological problems and poor academic performance. Treatment for CDGP depends on the individual and may include attempting to 'jumpstart puberty with testosterone injections for boys or testosterone replacement therapy for pre-pubertal males.
| Characteristics | Values |
|---|---|
| Description | A condition in which children experience delayed puberty compared to their peers of similar age. |
| Prevalence | Affects over 2% of adolescents, mainly boys. |
| Symptoms | Short stature, delayed bone age, delayed pubertal growth spurt, low insulin-like growth factor-1 secretion. |
| Causes | Genetic factors, familial history of late bloomers, idiopathic (no apparent reason). |
| Diagnosis | Evaluation of hormonal levels, exclusion of other disorders, family history, physical examination, radiographic study of left hand and wrist, growth measurements at frequent intervals. |
| Treatment | Testosterone injections, GnRH or GnRH agonist tests, testosterone replacement therapy, human growth hormone. |
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What You'll Learn
Short stature
CDGP is the most common cause of short stature and delayed puberty, affecting over 2% of adolescents, mainly boys. It occurs twice as frequently in boys as it does in girls. Children with CDGP experience a delay in the pubertal growth spurt, resulting in a lower height compared to their peers of similar ages. This delay in the pubertal growth spurt is associated with a delayed bone age, where bones mature at a slower rate than expected. The bone age is typically determined by examining the maturity of an individual's bones relative to what is expected for their age.
The management of short stature associated with CDGP may include attempting to "jumpstart" puberty, especially in boys, by administering monthly testosterone injections for 4-6 months. However, the decision to treat or not treat CDGP can be challenging, as the condition is considered a variant of normal growth rather than a disease. While delays in growth and sexual development may contribute to psychological difficulties, referral bias may also play a role in the perception that short stature is a cause of psychosocial problems.
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Delayed bone age
Constitutional delay in growth and puberty (CDGP) is a condition in which children experience a delay in puberty and the pubertal growth spurt compared to their peers of similar age. Children with CDGP have a short stature relative to their parents' heights and a delayed bone age.
Bone age is determined by examining the maturity of an individual's bones relative to what is expected for their age since birth. Typically, the bone age will be within a year of the child's age, and the adult height prediction will be within 2 to 3 inches of the estimated height based on parental heights. However, in cases of constitutional delay, bone maturation is generally delayed by longer than a year and often by two years or more. This means that the child will likely start puberty later than their peers and will continue to grow when others have finished, eventually reaching an adult height within the normal range for their family.
The delayed bone age in CDGP can be assessed through a bone age X-ray of the left hand and wrist. This X-ray measures the maturity of the bones and helps determine the child's bone age in comparison to their chronological age. If there is a significant delay in bone age, further investigations may be warranted to rule out other potential causes, such as growth hormone deficiency or endocrine and non-endocrine disorders.
While CDGP is considered a variant of normal growth rather than a disease, the associated short stature and delayed sexual development can lead to psychological problems and poor academic performance. Therefore, a prompt and precise diagnosis is essential for appropriate clinical management. Treatment options may include attempting to "jumpstart" puberty with testosterone injections for boys who have not started puberty by a certain age.
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Diagnosis and treatment
Constitutional growth delay (CGD) is a diagnosis of exclusion, and there is no consensus on the treatment. It is a variant of normal growth rather than a disease, but delays in growth and sexual development may contribute to psychological distress, which may warrant treatment.
Diagnosis
CGD is characterised by short stature and delayed bone age. A bone age x-ray is often used to predict the future height of the child, and the timing of their puberty. The bone age is determined by examining the maturity of the individual’s bones relative to what is expected for their age in years since birth. The bone age typically begins to lag during early childhood and is delayed in adolescence by an average of 2-4 years.
To diagnose CGD, several careful growth measurements are taken at frequent intervals, often every 6 months. These measurements are used to calculate linear height velocities and establish a trajectory on the growth curve. A radiographic study of the left hand and wrist to assess skeletal maturation is also critical in diagnosing CGD.
Other diagnostic considerations include taking a family history, including the timing of puberty in the mother and father, and performing a physical examination. In some cases, a physical examination alone may be sufficient for diagnosis.
Treatment
There is no standard treatment for CGD other than reassurance and monitoring. However, in adolescents experiencing psychological distress, treatment may be initiated. In boys with CGD, testosterone replacement therapy can be used to induce puberty, accelerate growth, and relieve psychosocial complaints. In girls with CGD, treatment with a limited dose of estradiol for up to 12 months is rare but may lead to breast development.
GH therapy has been approved for several diseases and has shown a favourable response on short-term growth rate and final height. However, there are still unresolved issues in the management of CGD, including the type, optimal timing, dose, and duration of sex steroid treatment.
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Temporary delay in skeletal growth
Constitutional delay in growth and puberty (CDGP) is a term used to describe a temporary delay in the skeletal growth and height of a child, with no physical abnormalities causing the delay. Children with CDGP have a short stature compared to their peers and experience delayed puberty. This condition is often inherited, with a family history of "late bloomers".
Children with CDGP have a delayed bone age, meaning their bones mature at a slower rate than expected. This can be assessed through a bone age examination, which involves an X-ray of the left hand and wrist to evaluate the child's skeletal development. If the child's bone age is lower than their chronological age, it may indicate constitutional growth delay.
The growth pattern of children with CDGP typically follows a unique trajectory. Between the ages of 3 to 6 months and 2 to 3 years, these children may exhibit variability in their growth and weight charts without any cause for concern. After this period, their growth tends to resume at a standard rate. However, it is during puberty that a noticeable deviation from the curve occurs due to their late onset of puberty.
While most children with CDGP will eventually catch up in height and experience puberty at a slightly faster pace, it is crucial to closely monitor their development. This includes tracking their growth velocity, BMI, weight for height, and pubertal stage. If puberty occurs earlier or at a faster tempo than anticipated, the child may not attain their expected adult height. Therefore, ongoing assessment and support are vital to ensure the well-being and healthy growth of children with CDGP.
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Psychological impact
Constitutional delay in growth and puberty (CDGP) is a common cause of delayed puberty, affecting over 2% of adolescents, mainly boys. While CDGP is considered a variant of normal growth rather than a disease, the associated short stature and delayed sexual development can lead to psychological problems. These psychological issues are sometimes associated with poor academic performance.
The psychological impact of CDGP can be significant, even leading to serious psychological disturbance in otherwise healthy children. The distress may be caused by bullying, the fear that puberty will never occur, and the emotional and psychosocial upset of immaturity. The associated short stature can also cause psychological difficulties, although it is suggested that referral bias may be responsible for the impression that short stature is a cause of psychosocial problems.
The delay in growth and sexual development can cause emotional distress, especially during adolescence, when children are highly conscious of their physical development and are sensitive to differences from their peers. The impact of CDGP can be exacerbated by the unpredictability of pubertal onset, which can make it challenging for specialists to determine the best course of treatment.
In some cases, the psychological impact of CDGP may persist into adulthood, particularly if the individual does not reach their predicted adult height. However, it is important to note that the majority of individuals with CDGP will eventually catch up and attain a normal adult stature and sexual development.
Early intervention and careful assessment are crucial in managing the psychological impact of CDGP. While treatment may not be necessary in all cases, it may be warranted for individuals experiencing severe psychological distress. Treatment options may include testosterone or oxandrolone therapy to induce puberty and advance growth, thereby alleviating the psychological concerns associated with the condition.
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Frequently asked questions
Constitutional delay in growth and puberty (CDGP) is a condition in which children experience a delay in puberty compared to their peers of a similar age. This is associated with a delay in the pubertal growth spurt, and children with this condition have a short stature relative to their parents' heights.
Children with CDGP experience a slowdown in linear growth within the first 3 years of life, followed by regular growth, albeit lower than their peers. At the average age of puberty, the height begins to move further from the growth curve due to a delay in the pubertal growth spurt. CDGP is associated with delayed bone age, where bones mature at a slower rate than expected.
Treatment of CDGP depends on the child and may include attempting to “jumpstart” puberty with monthly testosterone injections for boys. In pre-pubertal males, testosterone replacement therapy can be used to induce pubertal development and accelerate growth.
