Constitutional delay of growth and adolescence

Constitutional delay of growth and adolescence (CDGA) is characterized by simultaneous retardation of growth, skeletal maturation and sexual development. Primarily longitudinal growth is impaired. The late occurrence of puberty is a secondary phenomenon brought about by the retarded physical development. Plasma levels of sex hormones and gonadotrophin correlate with bone age, not with chronological age. The provocation tests for growth hormone (GH) show normal results. In contrast, the spontaneous secretion of GH, measured half-hourly through the night or over 24 hours, is markedly reduced. Plasma somatomedin C is diminished. According to these data, CDGA is not a genuine GH deficiency but represents a cybernetic disorder coinciding with a false threshold for GH. As shown by large series of investigations, the final height of the patients lies on average 1.85 SD below the mean of healthy adults, with large individual variations. The decision as to whether treatment by growth promoting hormones should be performed should be made with regard to the individual height prognosis. With GH in physiological doses growth velocity can be considerably increased. Bigger doses of the hormone appear to be necessary in order to enhance final height. Treatment by anabolics and testosterone increases height velocity only, not adult height.