A 13-year-old boy is brought for short stature; height is at the 3rd centile. His father was a 'late bloomer' and reached adult height after age 18. The boy's bone age is 11 years against a chronological age of 13 years. Puberty is Tanner stage 2. Growth velocity is low-normal, and systemic examination is normal. What is the most likely diagnosis?
- A Constitutional delay of growth and puberty ✓
- B Familial short stature
- C Growth hormone deficiency
- D Hypothyroidism
Correct answer: A. Constitutional delay of growth and puberty
Explanation
Constitutional delay shows short stature with delayed bone age matching the height age, a family history of late bloomers, delayed puberty, and preserved final adult height because growth continues after peers stop. Familial short stature is excluded because these children have a bone age equal to chronological age and enter puberty on time. Normal systemic examination and pubertal progression argue against GH deficiency and hypothyroidism.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.