Which of the following is NOT associated with a delayed bone age in a child with short stature?

• A. Hyperthyroidism
• B. Cushing syndrome
• C. Precocious puberty
• D. Growth hormone deficiency

Answer: (C)

Bone age reflects how quickly a child’s skeleton has matured compared to chronological age, and various endocrine conditions shift that maturation pace in different directions. When maturation is slowed, bone age falls behind the calendar age (delayed bone age), as seen with growth hormone deficiency or other factors that dampen growth. When maturation is sped up, bone age advances ahead of chronological age, as happens with early sex steroids in precocious puberty or with excess thyroid hormone.

Precocious puberty accelerates skeletal maturation due to early exposure to sex steroids, so bone age is typically advanced rather than delayed. That makes it the choice not associated with a delayed bone age. In contrast, growth hormone deficiency and Cushing syndrome commonly show delayed bone age, while hyperthyroidism tends to advance bone age.