Constitutional delay of growth and puberty

What is Constitutional Delay of Growth and Puberty?

Constitutional Delay of Growth and Puberty (CDGP) is the most common cause of short stature in males. It’s more common in males, but it can affect females too. CDGP is a variant of normal growth rather than a disorder, so often doesn’t require medical intervention^1-3.

People with CDGP may experience slower growth rate during childhood and adolescence, resulting in lower final adult height. They often go through puberty later than others their age but will likely reach full pubertal maturity before the age of 18. Another common feature is delayed bone age, meaning their skeletal maturation is younger than their actual age^1,2,4.

Whilst many children with CDGP go on to achieve normal adult height, they may remain shorter than their predicted adult height, calculated using their parents’ heights¹.

Hear advice from other parents whose children are also short in stature, compared with others their age. Click here.

What causes Constitutional Delay of Growth and Puberty?

Constitutional Delay of Growth and Puberty (CDGP) is thought to have a genetic cause, as it often runs in families. For more than 99% of cases the exact genetic cause remains unknown⁵.

What are the symptoms of Constitutional Delay of Growth and Puberty?

The main characteristics of CDGP are²:

• Slower growth rate
• Delayed puberty (In males, the absence of testicular enlargement by age 14. In females, the absence of breast development by age 13)
• Delayed skeletal maturation

Growth

The majority of children with Constitutional Delay of Growth and Puberty (CDGP) are identified when they don’t show signs of entering puberty. It can be diagnosed earlier as children with CDGP often follow a characteristic pattern of growth from early infancy³.

From 3–6 months old, babies with CDGP may begin to show signs of reduced growth rate³.

Growth rate is slowest in the first 2 years of life, so by age 3 children with CDGP are typically below average in height. Reduced growth rate is accompanied by reduced weight gain and delayed bone age, so children with CDGP remain aligned across these developmental markers³.

After 3–4 years of age, the growth rate of children with CDGP remains within normal limits, although their height lies below average³.

If your child is short in stature, keeping track of their growth can help identify if there is a problem early on. Compare your child’s measurements to the national average to see if they are within a healthy range.

Calculate your child’s growth

It is important to keep track of your child’s growth in order to identify if there is a problem early on. We recommend measuring your child every 6 months, which is now easier with our simple to use growth calculator.

Calculate

Are there any complications associated with Constitutional Delay of Growth and Puberty?

People who have experienced CDGP are at increased risk of developing certain conditions including^3,5:

• Decreased bone mineral density
• Poor self-esteem
• Social withdrawal

How is Constitutional Delay of Growth and Puberty diagnosed?

A doctor will only give a diagnosis of Constitutional Delay of Growth and Puberty (CDGP) after other possible causes of short stature and delayed puberty have been rejected^2,4.

To start, a doctor will first confirm a diagnosis of delayed puberty. In males this is the absence of testicular enlargement by the age of 14 and in females, this is the absence of breast development by the age of 13. Your doctor may ask you questions about your family history, as having another family member who has experienced delayed puberty increases the likelihood of your child having CDGP also⁴.

Other assessments that your doctor may carry out include assessing bone age and blood tests to check levels of sex hormones⁴.

It is important you speak to your doctor if you have any concerns about your child’s height. Use this helpful guide on what questions to ask and what to expect from your visit. Click here.

FAQ

How late can growth spurts start for children with Constitutional Delay of Growth and Puberty?

A child with Constitutional Delay of Growth and Puberty (CDGP) who has not received treatment will typically start their pubertal growth spurt after age 13.8 in males and age 12.2 in femalesm⁵.

What does it mean if bone age is delayed?

Having delayed bone age means, based on certain measurements, your child’s bone age appears younger than their actual age. Bone age is assessed using a wrist X-ray to determine how developed your child’s bones are. This can give an indication of how much more growing your child still has to dom¹.

Does Constitutional Delay of Growth and Puberty run in families?

Constitutional Delay of Growth and Puberty (CDGP) does run in families. 80% of people with CDGP have a first-degree relative (a parent, sibling or child) who has also experienced the conditionm^2,4.

References:

1 Rohani F et al. Endocrine Connections 2018;7:456–459.

2 Persani L et al. Endocrine 2021;71:681–688.

3 Frank GR. The Endocrinologist 2003;13(4):341–346.

4 Raivio T et al. Best Pract Res Clin Endocrinol Metab 2019;33:101316.

5 Cousminer DL et al. PLoS ONE 2015;10(6):e0128524.