A 13-year-old boy has Tanner stage 1 genital development, bone age of 11 years, and growth rate of 4 cm/year. His father started puberty at age 15. FSH and LH are prepubertal. Olfaction is normal. The most likely diagnosis and management is:
- A Constitutional delay of growth and puberty (CDGP) — reassurance; short course low-dose testosterone may be considered to address psychological concerns ✓
- B Hypogonadotropic hypogonadism — needs hormonal evaluation and GnRH stimulation
- C Klinefelter syndrome — karyotype and testosterone replacement
- D Kallmann syndrome — GnRH or gonadotropin therapy
Correct answer: A. Constitutional delay of growth and puberty (CDGP) — reassurance; short course low-dose testosterone may be considered to address psychological concerns
Explanation
Constitutional delay of growth and puberty (CDGP) is the most common cause of delayed puberty in boys. Features include delayed but concordant skeletal and sexual maturation, positive family history, normal olfaction, and normal basal gonadotropins. Final adult height is normal. Management is reassurance and watchful waiting; short-course low-dose testosterone (50 mg IM monthly for 3–4 months) can be offered to adolescents with significant psychological distress. Kallmann syndrome has anosmia and requires long-term GnRH/gonadotropin therapy.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.