A 14-year-old boy is evaluated for delayed puberty. He has no testicular enlargement (volume 2 mL bilaterally), no pubic hair, and short stature (below 3rd centile). His father recalls starting puberty at age 15 years. Bone age is delayed at 11.5 years. Which of the following findings best supports a diagnosis of constitutional delay of growth and puberty over hypogonadotropic hypogonadism?
- A Bone age consistent with height age rather than chronological age ✓
- b Family history of delayed puberty in father
- C Normal sense of smell
- D Absence of penile growth
Correct answer: A. Bone age consistent with height age rather than chronological age
Explanation
In constitutional delay, bone age is delayed but matches the child's height age, indicating proportional delay in skeletal maturation consistent with eventual catch-up growth. This pattern is characteristic of constitutional delay and helps distinguish it from hypogonadotropic hypogonadism, where such proportional delay is less consistently seen. Family history is supportive but not diagnostic. Both conditions can have normal smell. Absence of penile growth is present in both and does not differentiate.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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