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(2014) 20:627. 1, Fig. Children with short stature and no identified cause and children with certain other identifiable causes of short stature should be referred to a pediatric endocrinologist. Constitutional Delay of Growth and Puberty. [2][5] Studies of bone age in children allow physicians to correlate a child's current height and bone age to their predicted future maximum height in adulthood.[3][5]. Berlin; Heidelberg. (2014) 24:88993. Therefore, the bone maturation process can be better characterized by the evaluation of the knee region in children under the age of 3, while in those older than 3 years, the assessment of hand and wrist bones is the most appropriate (8082). Skeletal age estimation for forensic purposes: a comparison of GP, TW2 and TW3 methods on an Italian sample. /content/kidshealth/misc/medicalcodes/parents/articles/xray-bone-age, diseases that affect the levels of growth hormones, such as growth hormone deficiency, hypothyroidism, precocious puberty, and adrenal gland disorders, orthopedic or orthodontic problems in which the timing and type of treatment (surgery, bracing, etc.) Bone age delay is also associated with genetic syndromes such as trisomy 21, Turner syndrome, and RussellSilver syndrome (10, 4648). 113. [4] Other uses of bone age measurements include assisting in the diagnosis of medical conditions affecting children, such as constitutional growth delay, precocious puberty, thyroid dysfunction, growth hormone deficiency, and other causes of abnormally short or tall stature. Bone age is an interpretation of skeletal maturity. (2014) 16:424. doi: 10.1186/s13075-014-0424-1, 34. Assessment of bone age is also important for the correct diagnosis, particularly with the aim of detecting the causes of bone age alteration including mainly endocrine and nutritional causes and chronic nonendocrine disorders and syndromes. Samadi M, Rashid RJ, Ghaffari S, Shoaran M. Study on bone age in pediatric patients with congenital heart disease and its relation with cyanosis and pulmonary artery pressure. Pak J Med Sci. This method is valid for children above the age of 4. Most infants with the congenital form are normal size at birth, but may have episodes of hypoglycemia or prolonged jaundice. N Engl J Med. Thorne MC. This information, associated to the characterization of the shape and changes of bone components configuration, represent an important factor of the biological maturation process of a subject. doi: 10.1515/JPEM.1994.7.2.141, 129. 92. Available online at: www.thelocal.se/20170307/sweden-begins-newasylum-seeker-age-assessment-tests. (2014) 238:8390. [10][11] Since then, updated atlases of the left hand and wrist have appeared,[12][5] along with atlases of the foot and ankle,[13] knee,[14] and elbow. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Powell SG, Frydenberg M, Thomsen PH. Skeletal maturation in children with Cushing syndrome is not consistently delayed: the role of corticotropin, obesity, and steroid hormones, and the effect of surgical cure. Although aromatase inhibitors have been used in children with idiopathic short stature, long-term effectiveness and safety data are not available.27. (1992) doi: 10.1017/CBO9780511661655, 127. The Pediatric Endocrine Society website was searched for consensus statements and clinical guidelines. By evaluating the data obtained from bone age in the clinical setting, it is possible to distinguish three main groups of subjects: patients with delayed bone age, patients with bone age appropriate to chronological age, and patients with advanced bone age (3, 810). The mean bone age is advanced over chronological age by 3 years and results in decreased predicted adult height (-5 to -11 cm compared to target height). Hochberg Z. Endocrine Control of SkeletalMaturation. Am J Dis Child. (2009) 39:5917. [3] In certain instances, abnormal growth conditions may be treated with supplemental hormone therapy. Contemporary Pediatrics Resident Writer Program, Food Insecurity and the Dangers of Infant Formula Dilution, Getting into the Roots of Childhood Atopic Dermatitis, Opt-Out Chlamydia Screening in Adolescent Care, The Role of the Healthcare Provider Community in Increasing Public Awareness of RSV in All Infants, | Obstetrics-Gynecology & Women's Health. J Obstet Gynaecol Res. Bone age in the 21st century: is Greulich and Pyle's atlas accurate for Israeli children? (2012) 46:7709. Pediatr Radiol. Endocr Rev. A longitudinal study. Calculating the midparental height (Table 1) is an important part of the evaluation because most short or tall children have short or tall parents. Dense body parts, such as bones, block the passage of the X-ray beam through the body. doi: 10.1111/j.1651-2227.1984.tb09966.x, 15. doi: 10.1093/bmb/lds014. Health Phys. Cambridge. A healthy body mass index for age (BMI/A) is considered to be between 18.5 to 24.9kg/height/height. doi: 10.1136/bjsports-2012-091296. (2003) 349:77688. Therefore, the complete characterization of the main methods and procedure available and particularly of all their advantages and disadvantages need to be known in order to properly utilized this information for all its medical and non-medical main fields of application. Bone age may be affected by several factors, including gender, nutrition, as well as metabolic, genetic, and social factors and either acute and chronic pathologies especially hormone alteration. 2015;24(4):143-152. doi:10.1297/cpe.24.143. (2012) 216:200 e14. For this reason, in the TW3 method, skeletal age evaluation ends at 15 years in women and 16.5 years in men (while in the TW2 set, 18 and 19 years, respectively, with a bone maturity anticipation of 2.53 years) (120). doi: 10.1210/jc.2008-2474, 133. Apart from the ability to assess the chronological age of a person, the evaluation of growth remaining in a person can be extremely beneficial to a clinician in different circumstances, as previously discussed. Bass S, Pearce G, Bradney M, Hendrich E, Delmas PD, Harding A, et al. [24] Since most of the ossification centers counted using this technique appear early in life, this method is only valid for measuring bone age up to around 5 years of age. Khan K, Elayappen AS. 71. Bone maturation along the spectrum from normal weight to obesity: a complex interplay of sex, growth factors and weight gain. A systematic search has been performed in PubMed to identify randomized controlled trials (RCTs), meta-analyses, and retrospective and prospective studies of different methods to evaluate bone age, focusing on strengths and weaknesses of each procedure. Bone age advancement in prepubertal children with obesity and premature adrenarche: possible potentiating factors. doi: 10.1016/j.jflm.2013.11.011, 98. Clin Endocrinol Oxford. Age, height, weight, BMI z-score, and BA/CA were similar in the PA and control groups . Stature and skeletal maturation of two cohorts of Australian children and young adults over the past two decades. (1987) 79:7434. (2005) 32:31625. However, this system has some limits that must be considered, in particular, the absence of carpal bones evaluation, the opposition of local administrations to install the software, and the higher cost compared to available methods (GP and TW) (134). Projected height can be estimated by projecting the current growth curve to adulthood in children with normal bone age, or by using a bone age atlas in those with delayed bone age.. doi: 10.1297/cpe.24.143, 9. [29] A girl has reached 99% of her adult height at a bone age of 15 years and has a small amount of height growth left from this point on. In particular, estrogens and oral contraceptives or creams containing testosterone or estrogens can cause an early closure of the growth plate. 7. Other causes include renal, hepatic, and gastrointestinal diseases, and other genetic syndromes.1015, The initial evaluation of short stature (Figure 1) should include a history and physical examination, accurate growth assessment, calculation of the growth velocity and midparental height, and radiography to evaluate bone age.16 Drugs known to cause short stature include steroids (chronic use), attention-deficit/hyperactivity disorder medications, and anticonvulsants. Insulinlike growth factor has been used in children with insulinlike growth factor deficiency. 93. Children's bones have areas of new bone growth called growth plates at both ends. It's usually done by taking a single X-ray of the left wrist, hand, and fingers. Moreover, even when there is a good correlation between predicted and actual adult height, there is a wide individual variation, with almost 30% of adults differing by more than 5.0 cm from the BP predicted height (141). doi: 10.1542/peds.2009-3649, 140. Aicardi G, Vignolo M, Milani S, Naselli A, Magliano P, Garzia P. Assessment of skeletal maturity of the hand-wrist and knee: a comparison among methods. During puberty, the contours of the epiphyses begin to overlap, or cap, the metaphyses. Physical examination may reveal microphallus or midline craniofacial abnormalities. Rofo. For this reason, pediatricians should evaluate patients on the bases of all the available knowledge about the child, particularly their personal growth history. Moradi M, Sirous M, Morovatti P. The reliability of skeletal age determination in an Iranian sample using Greulich and Pyle method. Children with this condition are born appropriate for gestational age, but will then fall to the 3rd percentile for height during catch-down growth. (2009) 48:53843. Speiser PW. (2015) 7:1827. Ranjitkar S, Lin NH, Macdonald R, Taylor JA, Townsend GC. Bone age (BA) is a measure of the development of the skeleton incorporating the size, shape and degree of mineralization of the epiphyses and physeal plates of a bone to define their proximity to full maturity [1].BA differs from chronological age (CA), which is calculated from the date of birth and does not necessarily reflect an individual's stage of puberty. Particularly, the tables are based on the assumption that there is a correlation between the proportion of adult stature reached at that time and skeletal age. [1][2][21], The Tanner-Whitehouse (TW) technique of estimating bone is a "single-bone method" based on an x-ray image of a patient's left hand and wrist. X-rays should be perpendicular to the rigid plane and usually be performed with a tube of 4560 kVp potential. Tables are provided for ages 718 years. Consequently, when a naturally short child has an advanced bone age, it stunts their growth at an early age leaving them even shorter than they would have been. Ann Hum Biol. doi: 10.1016/S0022-3476(73)80481-0, 19. Discussion. 106. 4. 109. Instead, the variability among different operators (intervariability) is defined by the degree of variability in the interpretation of same data made by two different operators at the same time. doi: 10.1016/j.gcb.2008.09.020, 30. Each bone segment begins its maturation first in the primary ossification center and then, through different stages of enlargement and remodeling, reaches the final shape; many bones, like long bones, have many centers of maturation (epiphysis). First the capitate forms at an average age of 2 months, followed shortly by the hamate, then the triquetrum around 14 months, and so on.[44]. doi: 10.4103/0975-1475.176956, 76. doi: 10.1259/0007-1285-67-801-848, 95. Horm Res. The bones on the X-ray image are compared with X-rays images in a standard atlas of bone development, which . Ostojic SM. Just as there is wide variation among the normal population in age of losing teeth or experiencing the first menstrual period, the bone age of a healthy child may be a year or two advanced or delayed. The child's hand/ wrist X-ray is interpreted based on the appearance . J Pediatr Endocrinol. Growth and development: congenital adrenal hyperplasia-glucocorticoids and height. (2005) 35:42933. https://en.wikipedia.org/w/index.php?title=Bone_age&oldid=1141264025, Short description is different from Wikidata, Articles with unsourced statements from May 2020, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 24 February 2023, at 05:16. Those with an advanced bone age typically hit a growth spurt early on but stop growing at an earlier age. doi: 10.1080/03014469000001142, 117. Conclusion: Bone age calculated by Greulich & Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required (e.g. Bone age in children of diverse ethnicity. doi: 10.4158/EP13193.OR, 52. doi: 10.1093/med/9780199782055.001.0001, 10. Furthermore, the GP method has not been updated from its initial publication, representing important limits of applications especially in some ethnic groups such as African or Hispanic female subjects and in Asian and Hispanic male subjects during late infancy and adolescence (95, 96). Peak height velocity (PHV) occurs at the average age of 11 years for girls and at the average age of 13 years for boys. Author disclosure: No relevant financial affiliations. 2nd ed. (2009) 94:223944. In addition, biology and genetics can play a part . (2007) 51:5003. Bone age may be affected by several factors, including gender, nutrition, as well as metabolic, genetic, and social factors and either acute or chronic diseases, including endocrine dysfunction (39). Gaskin CM, Kahn SL, Bertozzi JC, Bunch PM. (2007) 173:14653. Furthermore, the image was digitized and transformed into a series of mathematical coefficients produced mostly from standard image of the left hand and wrist X-rays. [17][20] Finally, only the wrist and hand are imaged out of a desire to minimize the amount of potentially harmful ionizing radiation delivered to a child. Aust Orthod J. 3rd ed. Patel PS, Chaudhary AR, Dudhia BB, Bhatia PV, Soni NC, Jani YV. If the image is blurred, the X-ray technician might take another one. Although the Khamis-Roche method is considered an accurate predictor, it is not as accurate as methods using the bone age. As well several differences can be characterized according to the numerous standardized methods developed over the past decades. doi: 10.1007/s11102-010-0246-3, 26. doi: 10.1111/j.1754-4505.2008.00020.x. Crowne EC, Shalet SM, Wallace WH, Eminson DM, Price DA. The chronological age (CA) is the child's actual age, based on birth date. Table 6 includes the differential diagnosis of tall stature. Inflamm Bowel Dis. Look for a Mllerian anomaly as well. Is the assessment of bone age by the Greulich-Pyle method reliable at forensic age estimation for Turkish children? QJM. doi: 10.1016/0197-0070(87)90048-9, 84. [3] Large differences between a person's bone age and their chronological age may indicate a growth disorder. In patients with pituitary gigantism, octreotide (Sandostatin) and pegvisomant (Somavert) have been used to suppress the growth hormone.19. During a hand and wrist X-ray procedure, the child is exposed to <0.00012 mSv of radiation, thus lower than other daily physiological risk (86), however resulting in irrelevant relative risk of 40-year mortality equal to 5.1 108 (calculated for an exposure dose of 0.00015 mSv) (8789). Cavallo F, Mohn A, Chiarelli F, Giannini C. Evaluation of bone age in children: a mini review. (2015) 42:3027. Variability in the order of ossification of the bony centers of the hand and wrist. doi: 10.1136/adc.81.2.172, 94. A delayed bone age is common in malnourished conditions associated with chronic diseases such as intestinal inflammatory chronic diseases, celiac disease, and cystic fibrosis (2629). [1][6], Estimating the bone age of a living child is typically performed by comparing images of their bones to images of models of the average skeleton for a given age and sex acquired from healthy children and compiled in an atlas. See permissionsforcopyrightquestions and/or permission requests. Aynsley-Green A, Cole TJ, Crawley H, Lessof N, Boag LR, Wallace RM. Linklater A, Hewitt JK. Applicability of Greulich and Pyle skeletal age standards to Indian children. Pediatr Radiol. Maes M, Vandeweghe M. A valuable improvement of adult height prediction methods in short normal children. J Pak Med Assoc. doi: 10.1111/j.1365-2265.2010.03799.x, 33. These tables, the Bayley-Pinneau tables, are included as an appendix in the Greulich and Pyle atlas. Tall stature is defined as a height more than two standard deviations above the mean for age (greater than the 97th percentile). The mean growth velocity ranges from 8 to 10 cm/year, roughly +2 to +4 SD for chronological age, and results in increased heights, between +1.5 and +2.5 SD for age on average. Applicability of the Greulich and Pyle skeletal age standards to black and white children of today. In a recent poll, only 1 in 5 parents believed it is unsafe for children to take medicine past its expiration date, while many did not know how to properly dispose medicine. (1993) 147:132933. A comparison of radiation dose of two strategies for skeletal age estimation", "Bone age assessment of children using a digital hand atlas", "Traditional and New Methods of Bone Age Assessment-An Overview", "Book Review: Skeletal Maturity. Pediatrics. The Royal Children's Hospital Melbourne, Immigrant Health Service. Short stature is defined as a height more than two standard deviations below the mean for age, or less than the 3rd percentile. Bone age assessment: automated techniques coming of age? For patients two to 20 years of age, weight, height, and body mass index should be plotted. The carpal bones arise from primary ossification centers and continue their calcification in an outward manner. Lin NH, Ranjitkar S, Macdonald R, Hughes T, Taylor JA, Townsend GC. Patil ST, Parchand MP, Meshram MM, Kamdi NY. Degree of a person's skeletal development, Evaluation of the bones of the hand and wrist. Every 6-12 months, height and bone age should be assessed. In order to achieve a greater accuracy and diagnostic reproducibility, it is important that bone age determination has the lowest intra- and interoperator variability. Children with normal variants of height tend to have a normal growth velocity (5 cm [2 in] per year for children between five years of age and puberty) after catch-up or catch-down growth. (2017) 37:1925. (2013) 54:10249. (1990) 149:3147. The effect of chronic childhood malnutrition on pubertal growth and development. Underweight in a child with short stature suggests a systemic illness or malnutrition, whereas overweight suggests an endocrine disorder.2,21, Different causes of short stature tend to fall within identifiable growth patterns, and a review of a child's growth curve and bone age should guide further evaluation. Typically, children with this condition have a delayed bone age with a preserved or increased weight for age. Bone age is measured in years and assigned by a trained radiologist or endocrinologist by comparing the child's measurements with existing standards. Sustained decrease in bone-age-to-chronological-age (BA:CA) ratio through 5 years 3 Mean BA:CA ratio decreased throughout the study; . The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics recommend using the World Health Organization (WHO) growth charts for children younger than two years and the CDC growth charts for children older than two years.5 The CDC growth charts are a population-based reference that include data from bottle-fed and breastfed infants. doi: 10.1016/j.forsciint.2012.08.030, 105. doi: 10.1007/s00414-008-0237-3, 65. However, the GP method requires a continuous and long experience in order to optimize bone age determination. Bone age (BA) is a measure of the skeletal maturity of an individual and tells us about the growth potential of a child. A growth velocity that is less than normal should prompt further investigation. Congenital hypothyroidism leads to growth arrest, delayed bone age, and short stature at birth. Bone age for chronological age determination - statement of the European Society of Paediatric Radiology musculoskeletal task force group Bone age for chronological age determination - statement of the European Society of Paediatric Radiology musculoskeletal task force group Authors Gupta N, Lustig RH, Kohn MA, Vittinghoff E. Determination of bone age in pediatric patients with Crohn's disease should become part of routine care. doi: 10.1016/S0022-3476(52)80205-7, 138. (1988) 77:15460. Thiago O, Artiol MA, Alvares VS. Briers PJ, Hoorweg J, Stanfield JP. It is defined by the age expressed in years that corresponds to the level of maturation of bones. A score is assigned to each bone based on maturation and sex of the patient. A table of possible causes of abnormal stature and the expected bone age associated with each condition is provided below. The pattern of growth in children with constitutional tall stature from birth to age 9 years. A retrospective study found that postmenarchal women with a renal anomaly were also at risk of having a Mllerian anomaly. Assessments of skeletal maturity in prepubertal children are primarily based on the epiphyseal size of the phalanges as they relate to the adjacent metaphyses. Children do not mature at exactly the same time. 5. These look white on the X-ray image. Am J Orthod Dentofacial Orthop. J Forensic Sci. doi: 10.1530/EJE-15-0608, 60. Because the bone age of a child with endocrine diseases will progressively fall behind chronologic age, calculating bone age every 12 months might be useful to differentiate constitutional delay of growth from endocrine diseases.1, Children with endocrine disorders, such as growth hormone deficiency, hypothyroidism, or glucocorticoid excess, have normal to increased weight, whereas children with systemic disease tend to have decreased height and weight.2,21. Pediatr Endocrinol Rev. Data obtained by hand and wrist radiography during bone age assessment are also used in many nonmedical fields for example in sports (64) and for national policy in many countries (10). Nurs Res. Eur J Pediatr. For a child with average puberty timing, Kutney said pediatricians should expect the child to follow the height percentile consistent with their final adult height. doi: 10.2214/ajr.108.3.511, 108. Many of these parameters, and particularly growth spurt and menarche, correlate better with bone age compared to chronological age (4). Bone growth assessments can be useful when it comes to gauging growth rates, especially when it comes to understanding1: Pediatricians can look to a childs parents for some of this information, but more specialized assessments can help, particularly if there is a concern for any disorders or conditions that may affect growth, development, or bone health. Accessed November 22, 2021. https://kidshealth.org/en/parents/xray-bone-age.html, 2. 28. Arch Dis Child. (1994) 7:1415. (1989). Zafar AM, Nadeem N, Husen Y, Ahmad MN. It is important that not a simple comparison but an in-depth bone-by-bone evaluation is needed in order to properly characterized bone maturation. In Sweden, many asylum applications in 2016 were made by lone refugee children, thus requiring novel proposed guidelines. doi: 10.1109/42.108597, 128. doi: 10.1136/adc.68.5.677, 37. doi: 10.1002/ibd.22979, 31. CG has written sections of the manuscript. De Sanctis V, Soliman AT, Di Maio S, Bedair S. Are the new automated methods for bone age estimation advantageous over the manual approaches? Pathologic causes of short stature include chronic diseases; growth hormone deficiency; and genetic disorders, such as Turner syndrome. The images obtained by hand and wrist X-ray reflect the maturity of different bones. Constitutional advancement of growth in tall children is the equivalent of constitutional delay of growth and puberty in short children.1,19,20 Children with constitutional advancement of growth have accelerated growth until two to four years of age and then track parallel to the growth curve. Forensic Sci Int. Introduction. Tanner JM, Cameron N, Marshall WA, Healy MJ, Goldstein H. Assessment of Skeletal Maturity and Prediction of Adult Height. doi: 10.1016/j.legalmed.2011.01.004, 123. doi: 10.1007/s00247-008-1090-8, 131. (2010) 73:2208. Further, there can be moderate levels of variability in the bone ages assigned to the same patient by different assessors. doi: 10.1093/ajcn/36.3.527, 27. Hassel &Farman (1995)[27] developed an index based on the second, third, and fourth cervical vertebrae (C2, C3, C4) and proved that atlas maturation was highly correlated with skeletal maturation of the hand-wrist. The role of puberty in variations in BA is poorly understood as hypothalamic-pituitary-gonadal (HPG) axis maturation and skeletal maturation are regulated in parallel but independently by multiple different factors. Cox LA. X-ray exam: bone age study. doi: 10.1111/j.1651-2227.1988.tb10615.x, 46. 69. Manzoor Mughal A, Hassan N, Ahmed A. Infants born small for gestational age typically have catch-up growth in the first 24 months, but 10% have a final height more than two standard deviations below the mean for age.24 Children who do not have catch-up growth within the first six months or whose height is not within two standard deviations of the mean for age by two years of age may have a pathologic condition. Few pediatric devices were approved after a clinical trial involving children. [3][21], Images in the Greulich and Pyle atlas came from healthy white boys and girls enrolled in the Brush Foundation Study for Human Growth and Development between the years 1931 and 1942. (1973) 83:2336. Serinelli S, Panetta V, Pasqualetti P, Marchetti D. Accuracy of three age determination X-ray methods on the left hand-wrist: a systematic review and meta-analysis. (2009) 33:10914. (2005) 154:312. (127) started a computerization project of reading using phalanxes length compared to atlas. Tanner JM. In particular, the method of medical age assessment proposed consisted of taking X-rays of wisdom teeth and MRI scans of knee joints, which are then analyzed by dentists and radiologists. When do boys stop growing? doi: 10.1520/JFS2005020. Then the remaining centers appear, including Triquetrum at 2 years in females and 3 years in males, Lunate at 3 years in females and 4 years in males, Trapezium at 3 years in females and 4 years in males, Trapezoid at 4 years in females and 6 years in males, Scaphoid at 4 years in females and 6 years in males, Pisiform at 9 years in females and 12 years in males [77]. Clin Pediatr Endocrinol. It is important to highlight that all the available methods might be carefully used in the daily clinical approach in order to avoid unreliable expectation in children and parents. Means and standard deviations of weight, height, chronological age, SA, P-TW3 and P-KR were determined by group 1 and 2 (model and validation groups) and by sex, for all 497 (group 1 = 252; group . They add length and width to the bone. [24] The Sontag method uses x-rays of all the bones and joints of the upper and lower limbs on the left side of the body. MATERIALS AND METHODS: We measured CH on coronal CT scans of the temporal bone of 422 ears scanned from 2001 to 2007 in 211 patients, 1 month to 23 years of age. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department or the U.S. Army Service at large. They can be seen on an X-ray because they're softer and contain less mineral, making them appear darker on an X-ray image than the rest of the bone. Assessment of the carpals, metacarpals, and phalanges are used to find the closest match in the atlas; the chronological age of the patient in the atlas becomes the bone age assigned to the patient under review. Bone age is measured in years and assigned by a trained radiologist or endocrinologist by comparing the childs measurements with existing standards. This system does not take into account the state of carpus bones maturation and allows a bone age assessment between 2.5 and 17 years and 2.0 and 15.0 years for male and female individuals, respectively. doi: 10.1016/j.ajodo.2006.07.037, 99. New growth references for assessment of stature and skeletal maturation in Australians. Bone age is delayed if it is below this threshold (blue area), and advanced if it is above this threshold (green area). The use of AI as a monotherapy for children with NC-CAH has never been reported. (2009) 28:5266. The Local. Thodberg HH. It may take more than four years for a preterm infant who is born small for gestational age to attain a normal height.24, Recombinant growth hormone is approved for a variety of conditions that cause short stature, including Turner syndrome, chronic renal failure, Prader-Willi syndrome, small for gestational age, Noonan syndrome, short stature homeobox-containing gene deficiency, and idiopathic short stature. J Pediatr Endocrinol Metab. doi: 10.1002/ajhb.1310010206, 126. Chronological age and bone age were 8.7 4.0 and 8.8 4.3 years, respectively, for the entire population. On this Wikipedia the language links are at the top of the page across from the article title. In fact, the images obtained by hand and wrist X-ray reflect the maturity of different types of bones of the skeletal segment evaluated. These data distinguish these patients from patients with familial short stature, in whom bone age corresponds approximately to chronological age (1114).