Conversation: The conversation between human and AI assistant.
[|Human|] My grandson who is adopted from Guatemala and is 12 years old is in the 3rd lowest percentile on the growth curve. He is short and skinny. His mental capacities are fine and he is in 6th grade and doing pretty well. He has been diagnosed with ketonuria. He does not have diabetes. His pediatrician has ordered a wrist Xray to determine where he is on the growth curve, i.e. What various differential diagnoses should be considered and should any other tests be done? We do not know his biological father or his height but the biological mother was normal for a Guatemalan female. Thanks.
[|AI|]  Hello. I just read through your question. The x-ray is the standard first step in this evaluation. The result will determine if this is one of three conditions.1. Constitutional growth delay: his growth spurt begins a little later than other kids his age, but it will happen without intervention.2. Familial short stature: his biological family is short, and so he will be short.3. Growth hormone deficiency: growth hormone treatment will be required. This is typically managed by an endocrinologist. Your pediatrician will direct you appropriately.