Endocrine manipulation of constitutional delay in growth and puberty

Abstract The association of delayed growth and puberty is a common adolescent problem. It is most often attributable to a variation in normal development, and thus is considered 'constitutional' in origin. The diagnosis of delayed puberty is defined arbitrarily, and is fulfilled if a child fails to attain the first stage of sexual maturation at an age when 97% of a normal population will have done so. Thus a boy who has a testicular volume below 4 ml at the age of 14 years or a girl who has no evidence of breast budding by 13·2 years demonstrate delayed sexual development. However, a pattern of delayed growth has often been present throughout childhood. Thus in the prepubertal years, children with constitutional delay in growth and puberty (CDGP) are short in relation to parental height, have a retarded bone age and often a family history of delayed maturation. During the pubertal years,