Growth & Puberty Disorders

Growth is the most sensitive indicator of a child's health, and a growth chart plotted over time reveals more than any single measurement. Most short children are healthy — familial short stature and constitutional delay account for the majority — but a minority have a treatable endocrine or systemic cause, and finding those children before the growth plates fuse is what makes this an urgent rather than a routine referral.

Short stature

Assessment begins with accurate serial measurements, growth velocity, mid-parental height and pubertal staging, then looks for the causes that matter: hypothyroidism, growth hormone deficiency, coeliac disease, chronic kidney disease, poorly controlled asthma or its treatment, Cushing's syndrome, and in girls Turner syndrome, which is frequently diagnosed late. A bone-age radiograph and, where indicated, growth hormone stimulation testing complete the picture. Growth hormone therapy is genuinely transformative in the specific conditions for which it is indicated, and of no benefit in the many for which it is not — a distinction worth being clear about.

Delayed puberty

Often simply constitutional and familial, but hypogonadism, chronic illness, eating disorders and pituitary disease must be considered. Treatment, where needed, induces puberty in a physiological sequence and at a pace appropriate to the child.

Precocious puberty

Puberty beginning too early shortens the growing period and can cause real distress. Its cause is more often significant in boys than in girls, and it is investigated accordingly. Effective treatment exists to pause pubertal progression where that is the right course.

Disorders of sexual development

Ambiguous genitalia at birth, or an unexpected mismatch discovered later, requires urgent, careful and unhurried multidisciplinary assessment. Dr Ghosh has published on a rare 46,XX male sex-reversal syndrome and on ectopic thyroid tissue in unusual locations.