Accelerated pubertal onset in short children with delayed bone age

Area of Science:

• Pediatric Endocrinology
• Growth and Development
• Human Genetics

Background:

• Constitutional delay of growth (CDG) typically involves delayed puberty and subsequent catch-up growth.
• However, some individuals experience earlier-than-expected pubertal onset, potentially limiting adult height.
• Understanding the incidence of this phenomenon is crucial for accurate diagnosis and management.

Purpose of the Study:

• To investigate the current incidence of earlier-than-expected pubertal onset in children with constitutional delay of growth (CDG).
• To compare the current incidence with data from approximately 30 years prior.
• To identify factors associated with earlier pubertal onset in CDG.

Main Methods:

• Retrospective analysis of 1,312 Japanese children with short stature (2010-2018) and 11,256 individuals from a historical cohort (1979-1992).
• Inclusion criteria: height SDS <-1.0, bone age/chronological age ratio <0.8, and absence of other short stature causes.
• Pubertal growth onset determined auxologically; earlier onset defined as >1 year before population average.

Main Results:

• In the recent cohort, 34.2% of boys and 29.4% of girls with CDG exhibited earlier-than-expected pubertal onset.
• In the historical cohort, earlier onset was less frequent (13.0% of boys, 14.8% of girls).
• No significant association found between earlier onset and bone age/chronological age ratio, IGF-1, or midparental height.

Conclusions:

• Earlier-than-expected pubertal growth onset is a common occurrence in children with constitutional delay of growth (CDG).
• The incidence of this phenomenon appears to be increasing over time.
• This finding has implications for predicting adult height in children diagnosed with CDG.