A 14-year-old boy presents with short stature. His height is at the 3rd centile, and growth velocity is 4 cm/year over the past year. His father reports starting shaving at age 16. Bone age is 11 years (delayed by 3 years). FSH and LH are prepubertal. Testosterone is low. He is otherwise healthy with normal systemic examination. What is the most likely diagnosis?

• A Growth hormone deficiency
• B Hypothyroidism
• C Idiopathic short stature
• D Constitutional delay of growth and puberty ✓

Explanation

Constitutional delay of growth and puberty is characterized by short stature, delayed bone age (typically >2 years behind chronological age), delayed puberty, and a family history of delayed puberty. Growth velocity is low-normal but appropriate for bone age. Idiopathic short stature has normal bone age matching chronological age. Growth hormone deficiency has very low growth velocity and proportional short stature. Hypothyroidism causes severely delayed bone age with additional systemic features.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.