Overview Constitutional growth delay Introduction the most common cause of short stature and pubertal delay adolescents will have a normal growth spurt and normal adult height Presentation normal birth weight and height drop in percentiles on growth curve between 6 months and 3 years, re-establishment of normal growth velocity and following the growth curve at the 5th to 10th percentiles Evaluation characterized by a bone age that is less than chronological age the child's short height is often appropriate when assessed in the context of their skeletal age. TSH best next step in management when a child falls off their growth curve Treatment reassurance and regular follow-up Precocious puberty going through puberty at a younger age than is expected < 8 for girls, < 9 for boys if advanced bone age: Central: high FSH and LH may be caused by CNS tumors order head CT/MRI to rule out secondary causes Peripheral: low FSH and LH abnormal secretion of sex hormones from ovaries/testes/adrenal glands if normal bone age: isolated premature thelarche isolated premature adrenarche can occur secondary to obesity