Bone Age, Advanced
Catherine C. Roberts, MD
DIFFERENTIAL DIAGNOSIS
Common
Familial Tall Stature
Idiopathic Precocious Puberty
Excessive Sex Hormone
Juvenile Idiopathic Arthritis (JIA)
Hemophilia
Physeal Fractures
Radiation-Induced Growth Deformities
Less Common
Hyperthyroidism
Hypothalamic Mass
Pituitary Gigantism
Adrenocortical Tumor
Adrenal Hyperplasia
Exogenous Obesity
Ectopic Gonadotropin Tumor
Polyostotic Fibrous Dysplasia, McCune-Albright
Rare but Important
Chronic Septic Arthritis, Nonbacterial
Encephalitis
Primary Hyperaldosteronism
Beckwith-Wiedemann Syndrome
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Skeletal maturation more than 2 standard deviations above mean
Determining etiology highly dependent on lab findings and clinical presentation
Marked advancement in bone age is more likely to indicate elevated sex hormones
Helpful Clues for Common Diagnoses
Excessive Sex Hormone
Induces early growth plate maturation
Juvenile Idiopathic Arthritis (JIA)
Chronic hyperemia causes growth centers to ossify early, enlarge, & fuse prematurely
Hemophilia
Similar JIA, + dense effusion
Radiation-Induced Growth Deformities
Vascular obliteration → premature fusion
Associated with bone hypoplasia, slipped capital femoral epiphysis, scoliosis
Watch for port-like distribution
Associated radiation-induced sarcoma
Helpful Clues for Less Common Diagnoses
Hypothalamic Mass
Early onset of normal maturation process
Hypothalamic hamartoma or mass effect from suprasellar tumors
Adrenocortical Tumor or Hyperplasia
Hypersecretion of androgens and cortisol
Ectopic Gonadotropin Tumor
Hepatoblastoma/teratoma/chorioepithelioma
Polyostotic Fibrous Dysplasia, McCune-Albright
“Ground-glass” bone lesions + café-au-lait spots + precocious puberty
Other Essential Information
MR brain to exclude hypothalamic lesion
Pelvic ultrasound (females) for evidence of gonadotropin/estrogen stimulation
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