Clinical scenario:
A 5-year-old boy is brought for evaluation of poor growth. His height is below the 3rd percentile and has progressively fallen from the 25th percentile over the past 2 years. His weight has also declined from the 25th to below the 5th percentile. His dietary history reveals inadequate caloric and protein intake. He appears thin, with reduced muscle mass and subcutaneous fat. His bone age is delayed by approximately 2 years. There are no dysmorphic features, skeletal abnormalities, or clinical features of endocrine disease.
A. Chronic malnutrition
B. Cushing syndrome
C. Growth hormone deficiency
D. Hypothyroidism
E. Skeletal dysplasia
Correct answer & Explanation:
Answer: A. Chronic malnutrition
Explanation
Chronic nutritional deficiency typically causes proportionate growth retardation, with both height and weight affected. The weight remains appropriate for the child’s reduced height, and bone age is delayed in proportion to growth.
In contrast, endocrine causes such as growth hormone deficiency and hypothyroidism often cause poor linear growth with relative preservation or increase of weight for height. Skeletal dysplasias usually produce disproportionate short stature and characteristic skeletal findings.
The combination of progressive linear growth failure, delayed bone age, and weight appropriate for height is therefore most consistent with chronic nutritional growth retardation.
