Constitutional growth delay presents in patients:

• who has parents of normal stature but demonstrates short stature
• delayed pubertal development
• slow but consistent growth velocity
• A bone age less than chronological age.

It is associated with normal development and stature once the patient reaches puberty.

DDX:

• Familial short stature typically presents in a patient whose parents are both of short stature with a normal growth velocity and bone age consistent with chronological age. They will remain of short stature into adulthood.

• GH deficiency can present in infancy or childhood, depending on the severity of deficiency. Acquired growth hormone deficiency is typically caused by a nonfunctional pituitary tumor and presents with severe growth delay and a bone age younger than chronological age. It is associated with a rapid decline in the height-for-age curve, crossing percentiles.

• Hypopituitarism presents with short stature, fatigue, hypotension, cold intolerance, constipation, amenorrhea or oligomenorrhea in women, and decreased libido in men, as well as decreased development of secondary sexual characteristics.

• Hypothyroidism in adolescents can present with short stature and growth delay but it would be expected to present with other signs of hypothyroidism, such as fatigue, weight gain, cold intolerance, and constipation.

• Steroid-induced growth failure is seen in patients on chronic systemic steroid therapy as a result of the negative feedback on growth hormone secretion and inhibition of collagen and bone formation. (While this patient takes daily inhaled steroids, this local delivery of steroids to the respiratory tract would be unlikely to cause growth issues. )