Growth curve of a representative patient.

Growth failure (“shifting” of height percentiles) was evident for about 2 years prior to admission. The weight of this patient was at the 25th percentile at age 12 years, and had shifted to considerably below the 3rd percentile during the two years prior to hospitalization. She had virtually no linear growth during the 2 years preceding her admission, with her height decreasing from the 90th percentile to the 50th percentile. Thus, her apparent “normal” height at the time of admission, may reflect growth failure related to delayed diagnosis. Growth deceleration may not have been noted, because height was at or above the 50th percentile, and the patient was probably still perceived as normal compared to her peers. Weight rehabilitation resulted in catch-up growth.