Constitutional short stature

Constitutional delay of growth and puberty may be diagnosed in short adolescents who have delayed puberty, a delayed bone age, and no underlying illness.

• this a diagnosis of exclusion
• this diagnosis has been associated with psychological difficulties and deviant behaviour
• adults with constitutional delay of puberty and growth have a short spinal length compared to leg length
• treatment with sex or anabolic steroids is an effective and safe treatment that achieves secondary sexual characteristics, but does not improve final height
• it has been shown that oestrogen is the predominant hormone that leads to epiphyseal closure in both sexes. Aromatase inhibitors block the conversion of testosterone to oestrogen. Thus the combination of testosterone therapy and a specific aromatase inhibitor has potential as an effective treatment of constitutional pubertal delay in males. In this therapeutic option the testosterone provides a growth spurt and virilisation, while the aromatase inhibitor delays epiphyseal closure and thus allows growth over a longer period of time

Reference:

• (1) Lancet (2001), 357 (9270), 1723-4