$Unique_ID{BRK03791} $Pretitle{} $Title{Growth Delay, Constitutional} $Subject{Growth Delay Constitutional Constitutional Delay in Growth and Puberty CDGP Constitutional Short Stature Idiopathic Growth Delay Idiopathic Short Stature Physiologic Delayed Puberty Sporadic Short Stature Short Stature Growth Hormone Deficiency Hypochondroplasia Vitamin-D Deficiency Rickets Turner Syndrome} $Volume{} $Log{} Copyright (C) 1991 National Organization for Rare Disorders, Inc. 865: Growth Delay, Constitutional ** IMPORTANT ** It is possible that the main title of the article (Constitutional Growth Delay) is not the name you expected. Please check the SYNONYMS listing to find the alternate name and disorder subdivisions covered by this article. Synonyms Constitutional Delay in Growth and Puberty (CDGP) Constitutional Short Stature Idiopathic Growth Delay Idiopathic Short Stature Physiologic Delayed Puberty Sporadic Short Stature Short Stature Information on the following diseases can be found in the Related Disorders section of this report: Growth Hormone Deficiency Hypochondroplasia Vitamin-D Deficiency Rickets Turner Syndrome General Discussion ** REMINDER ** The Information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Constitutional Growth Delay is a term describing a temporary delay in the skeletal growth and height of a child with no other physical abnormalities causing the delay. Short stature may be the result of a growth pattern inherited from a parent (familial) or occur for no apparent reason (sporadic). Typically there is a period during childhood in which growth slows down, eventually resuming at a normal rate. Symptoms Children with Constitutional Growth Delay have a period in which skeletal growth and height are delayed. During this period the child's height on a growth chart is usually below the 5th percentile. Typically, the child who eventually has a delay in growth is born at a normal height and weight and may grow at a normal rate for as much as two years. When testing is done, there is no physical impairment causing the delay. There is often a history of this delay in growth occuring in other members of the family. If a parent was small as a child, with a late onset of growth and/or puberty (eventually falling within the normal range), the child may follow the same pattern. This form of Constitutional Growth Delay is referred to as familial. Some children may experience a period of delayed growth for no known reason (sporadic). Normally puberty begins when the bone age reaches 10 1/2 years in females and 11 1/2 years in males. The chronologic age of puberty in children with Constitutional Growth Delay is usually later. The rounded head of the long bones in children is separated from the shaft of the bone by the growth plate. The growth plate is the area where much of the growth takes place. When the bone stops growing, the growth plate becomes solid. This process is known as fusion of the epiphyses. The normal age for the epiphyses to fuse is age 15 in females and age 18 in males. Female adolescents with Constitutional Growth Delay typically continue growing until they are 17 or 18, while males may continue to grow into their early 20's. Puberty is normal in adolescents with CGD except for the delay in age. Adult height is within the normal range. In some patients the skeletal age is not delayed as much as the height age. Causes The exact cause of Constitutional Growth Delay is not known. In some cases the pattern of growth delay follows that of another family member. If a parent was small as a child and has a late onset of growth and puberty the child may follow the same pattern. A deficiency of growth hormone can be ruled out through laboratory tests in cases where other physical and genetic factors are not apparent. Affected Population Constitutional Growth Delay is a prevalent condition affecting males and females. Many more boys seek help than girls. Approximately 35% of all children with short stature have CGD. Related Disorders Symptoms of the following disorders can be similar to those of Constitutional Short Stature. Comparisons may be useful for a differential diagnosis: Growth Hormone Deficiency (GHD) causes an absence or delay of lengthening and widening of the skeletal bones inappropriate to the chronological age of the child. A sufficient quantity of growth hormone is required during childhood to maintain growth and normalize sexual maturity. In some cases the onset of the disorder occurs prenatally, in others the condition occurs months or years later. Laboratory testing is necessary before a diagnosis of Growth Hormone Deficiency can be made. (For more information on this disorder choose "Growth Hormone Deficiency" as your search term in the Rare Disease Database). Hypochondroplasia is a rare inherited skeletal disorder. The major symptom of this disorder is dwarfism that does not become evident until mid- childhood. Hypochondroplasia is characterized by a normal sized head and small but normally shaped hands and feet. Children with this disorder appear normal at birth but the limbs fail to develop properly. (For more information on this disorder, choose "Hypochondroplasia " as your search term in the Rare Disease Database). Vitamin-D Deficiency Rickets is a rare disorder that appears during infancy and childhood. It is caused by insufficient amounts of vitamin D in the body. This deficiency can be caused by poor nutrition, a lack of exposure to the sun, or malabsorption syndromes in which the intestines do not adequately absorb nutrients from food. Symptoms of this disorder may be restlessness, lack of sleep, slow growth, a delay in crawling, sitting or walking, thinness of the top and back of the skull, swelling of the skull and a delay in the closing of the skull bone. (For more information on this disorder choose "Rickets" as your search term in the Rare Disease Database). Turner Syndrome is a rare inherited disorder affecting females. The main symptoms of this disorder are a lack of sexual development, small stature, possible mental retardation, a webbed neck, heart defects and various other congenital anomalies. Individuals with this disorder have an XO Kerotype, i.e., they have neither the second X chromosome that characterizes females nor the Y chromosome of males. Individuals with Turner Syndrome have female characteristics, but they do not develop secondary sexual characteristics. (For more information on this disorder choose "Turner" as your search term in the Rare Disease Database). Disorders that are often associated with short stature such as Juvenile Diabetes, Cystic Fibrosis, kidney diseases, asthmatics that have inhaled steroids, etc., must all be ruled out in order to be certain that the short stature has no known cause. Therapies: Standard Treatment of Constitutional Growth Delay is not recommended since affected children will eventually grow to a height within the normal range. Typically a child will get through this lull in growth with no problems. Occasionally there may be psychological problems associated with short stature and counseling as well as family and peer support may be necessary. When severe psychological symptoms are apparent, drugs may be prescribed in conjunction with counseling. These may include male hormones including anabolic steroids. This treatment should be done with caution under careful medical supervision and frequent x-rays should be taken to make sure that the skeletal age is not being advanced too much. When bone development is increased faster than height it can reduce the growing period and ultimately reduce the patient's adult height. Steroids can have severe physical and behavioral side effects so this treatment is rarely recommended. Therapies: Investigational Treatment with recombinant human growth hormone (hGH) is recommended only for children with documented growth hormone deficiency as confirmed through laboratory tests. The use of hGH on healthy short children is controversial since long-term consequences are unknown. The Orphan Drug Testosterone (Sublingual) is currently being tested for treatment of Constitutional Delay of Growth and Puberty in boys. The Orphan Drug Oxandrolone is currently being tested for use in the treatment of Constitutional Delay of Growth and Puberty. Both drugs are sponsored by: Gynex, Inc. 1175 Corporate Woods Parkway Deerfield, IL 60015 This disease entry is based upon medical information available through October 1991. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Constitutional Growth Delay, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 The Magic Foundation 1327 N. Harlem Ave. Oak Park, IL 60302 (708) 383-0808 Human Growth Foundation (HGF) 7777 Leesburg Pike P.O. Box 3090 Falls Church, VA 22043 (703) 883-1773 (800) 451-6434 Short Stature Foundation 17200 Jamboree Rd., Suite J Irvine, CA 92714-5828 (714) 474-4554 800-24 DWARF NIH/National Institute of Child Health and Human Development 9000 Rockville Pike Bethesda, MD 20892 301-496-5751 References INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, Editor-In-Chief; Little, Brown and Co., 1987. Pp. 1986-88. CECIL TEXTBOOK OF MEDICINE, 19th Ed.: James B. Wyngaarden, and Lloyd H. Smith, Jr., Editors; W.B. Saunders Co., 1990. Pp. 1418. CLINICAL PEDIATRIC ENDOCRINOLOGY, Solomon A. Kaplan M.D., W.B. Saunders Company, 1990. Pp. 10, 49-53. GROWTH HORMONE THERAPY: L. Shulman, et al.; Am Family Physician (May, 1990, issue 41(5)). Pp. 1541-6. TESTERONE TREATMENT IN ADOLESCENT BOYS WITH CONSTITUTIONAL DELAY IN GROWTH AND DEVELOPMENT: R.A. Richman, et al.; N Engl J Med (December 15, 1988, issue 319(24)). Pp. 1563-7. DOUBLE BLIND PLACEBO CONTROLLED TRIAL OF LOW DOSE OXANDROLONE IN THE TREATMENT OF BOYS WITH CONSTITUTIONAL DELAY OF GROWTH AND PUBERTY: R. Stanhope, et al.; Arch Dis Child (May, 1988, issue 63(5)). Pp. 501-5. TREATMENT OF SHORT STATURE AND DELAYED ADOLESCENCE: D.M. Wilson, et al.; Pediatr Clin North Am (August, 1987, issue 34(4)). Pp. 865-79.