A 3½-year-old girl whose height falls below the fifth percentile has an estimated bone age of 6 years. Her birth at full-term was unremarkable, and her weight and developmental milestones are all normal. There is no clinical or biochemical evidence of congenital adrenal hyperplasia or precocious puberty. What could be causing her advanced bone age?
—Arun Kannan, MD, Cochin, Kerala, India
Causes of advanced bone age relate to several pathological conditions accompanied by increased levels of sex steroids. These include precocious puberty, androgen exposure, congenital adrenal hyperplasia, and obesity. All are associated with accelerated bone maturation. Thus, children with these conditions have accelerated early growth but end up with reduced final height.
Cushing’s syndrome has been known to have similar effects, although the bone age is usually normal or slightly increased. This patient is young enough that precocious puberty could be on the horizon, but investigate the adrenal glands to make sure there are no tumors or abnormal growths at this time. I would be curious to know her BP.
—Michael E. Ryan, DO (101-2)