The physician must decide whether a boy of fourteen years or a girl of thirteen years without signs of pubertal development might harbour an organic disorder or simply have a variation of the normal developmental pattern - constitutional delay in growth and adolescence. Historical factors may help to confirm the diagnosis of constitutional delay (Fig. 13.27). If the story is not characteristic for one condition or the other, however, and if the physical examination does not add to the diagnosis by the demonstration of some phenotypic anomaly, laboratory diagnosis is necessary.
