Which feature in his clinical presentation most strongly suggests a diagnosis other than constitutional delay?

A 16-year-old boy was referred with concern about delayed puberty. His stature had been short as a child. He reported an increase in height at the age of 13, and had begun to develop pubic hair at the age of 14. He reported no further growth or development in the past year. His father recalled going through puberty at the age of 13.

On examination, his height was 1.60 m (between 0.4th and 2nd centile), weight was 56.4 kg (between 9th and 25th centile), genital development was Tanner stage 2 and testicular volume was 8 mL bilaterally. Pubic hair was Tanner stage 2, with no evidence of androgenic axillary hair. Bone age at the left wrist was 13.5 years.

Investigations:

serum testosterone2.9 nmol/L (9.0C35.0)

Which feature in his clinical presentation most strongly suggests a diagnosis other than constitutional delay?
A . 2.5-year delay in bone age
B . absence of axillary hair in the presence of pubic hair
C . being below the 2nd centile for height
D . discordance between the height centile and the weight centile
E . failure to progress through puberty

View Answer

Answer: E