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Licensed Unlicensed Requires Authentication Published by De Gruyter January 14, 2016

Growth failure in adolescents: etiology, the role of pubertal timing and most useful criteria for diagnostic workup

  • Susanne E. Stalman EMAIL logo , Ilse Hellinga , Jan M. Wit , Raoul C.M. Hennekam , Gerdine A. Kamp and Frans B. Plötz


Background: The aim of the study was to evaluate the etiology, the role of pubertal timing and most useful criteria for diagnostic workup in adolescents with growth failure.

Methods: Adolescents (n=182) aged 10.0–18.0 years underwent a standardized diagnostic protocol. Constitutional delay of growth and puberty (CDGP) was defined as late pubertal onset or a Tanner stage less than –2 SDS. Dutch and Finnish criteria for growth monitoring were retrospectively assessed.

Results: In 13 children (7.1%) a specific diagnosis could be established. CDGP was diagnosed in 10% of patients aged ≥13 (girls) or ≥14 years (boys). Sensitivity to detect pathologic causes was 85% and 62% for, respectively Dutch and Finnish criteria for growth monitoring as used in younger children, but specificity was low (55%–59%).

Conclusions: In adolescents, pathological causes for growth failure and pubertal delay are common, and we recommend a combination of height SDS, distance to THSDS and growth deflection for deciding on further diagnostic testing.

Corresponding author: Susanne E. Stalman, MD, Academic Medical Center, Department of Pediatrics, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands, Phone: +31 20 5668844, Fax: +31 20 5664440


We wish to thank Antti Saari, Ulla Sankilampi and Leo Dunkel for providing us with the algorithms of the Finnish referral criteria; and Bea Jansen van ‘t Land, Desirée Paap, Lidi Schilperoort, Irene Bergsma and Ingrid van de Woude (specialized nurses of the Tergooi growth clinic, Tergooi Hospitals, Hilversum, The Netherlands) for their good care of the patients at the growth clinic and for performing accurate auxological measurements.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. The sponsor had no involvement in the study. The authors declare that they have no conflicts of interest to disclosure. All authors certify that this manuscript has not been published or is being considered for publication elsewhere.

Research funding: Funding was provided by Tergooi Hospitals, Blaricum, The Netherlands.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Received: 2015-7-3
Accepted: 2015-11-23
Published Online: 2016-1-14
Published in Print: 2016-4-1

©2016 by De Gruyter

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