Constitutional growth delay

Child

Constitutional growth delay (CGD) describes a temporary delay in the skeletal growth, consequently affecting the height of a child, without the presence of any other physical abnormalities causing the delay. Originating either from an inherited growth pattern or for no identifiable reason, CGD remains the leading cause of short stature and delayed puberty.

History

Short stature due to CGD may be the consequence of an inherited growth pattern from a parent (familial) or it can manifest without any discernible cause (idiopathic). Generally, during childhood, there's a discernible reduction in growth speed, which eventually regains its normal pace.

Pathophysiology

CGD is characterized by a comprehensive delay in development influencing every organ system. The delays in both growth and sexual development are evaluated using the skeletal age, determined from bone age radiographic studies of the left hand and wrist. Growth rates and development align more with the individual's biological age rather than their chronological age, leading to delayed growth and development patterns.

Child development stages

Epidemiology

Of the patients referred for endocrinological evaluation due to short stature, about 15% are diagnosed with CGD. Together, individuals with CGD and familial short stature account for roughly 23%. It's important to note that the actual frequency of CGD might be understated since those with milder delays or without psychological stress might not seek specialist care.

Mortality and Morbidity

CGD, as a variant of regular growth, does not elevate mortality risks. Nevertheless, some individuals may face considerable psychological stress, potentially leading to a negative self-perception and social withdrawal. Recent research indicates potential risks for decreased bone mass in adults, attributed to delayed sex steroid effects during adolescence.

Frequency

Epidemiological data suggest that growth variations, akin to CGD, appear twice as commonly in boys as in girls. However, referrals for short stature indicate an even larger gender disparity, possibly due to heightened concerns surrounding boys who are shorter than their peers or those experiencing delayed sexual development. The growth patterns emblematic of CGD can be observed as early as 3-6 months of age, but medical consultations are usually deferred until puberty when delayed sexual development and growth discrepancies become more noticeable.

Clinical History

Typically, CGD-afflicted individuals exhibit normal size at birth. Within the first 3-6 months, there is a notable deceleration in height and weight velocity. Most children, however, regain normal growth speed by ages 2-3. Skeletal age, a key metric in CGD diagnoses, often shows delays by late childhood, more reflective of the child's height age than chronological age. This delay also often coins the term "late bloomers" for these children, as their growth spurt and onset of puberty, which are tied to skeletal age, are delayed.

Physical Appearance

A cursory physical examination will typically reveal an age-incongruent, immature appearance in CGD patients. Body proportions might also depict the growth delay, with childhood proportions possibly exceeding standard measurements. However, by adulthood, due to prolonged leg growth, these ratios often normalize.

Causes

It's believed that CGD is inherited through multiple genes from both parents. The predominant role of heredity is evident in the 60-90% likelihood of detecting similar growth patterns within family members. One theory proposes a delay in the reactivation of the hypothalamic-pituitary pulse generator leading to delayed puberty onset.

Synonyms

• Constitutional Delay in Growth and Adolescence (CDGA)
• Constitutional Delay in Growth and Puberty (CDGP)
• Constitutional Short Stature (CSS)
• Delayed Growth
• Idiopathic Growth Delay (IGD)
• Physiologic Delayed Puberty
• Sporadic Short Stature

See also

• Idiopathic short stature

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