IGF1 and Delayed puberty: The growth plate fusion is usually delayed until the end of the second decade of life.2 The pathogenesis of growth failure is multifactorial3,4 and is mainly due to chronic anemia and hypoxia, chronic liver disease, zinc and folic acid deficiency, iron overload, intensive use of chelating agents, emotional factors, endocrinepathies (hypogonadism, delayed puberty, hypothyroidism) and GH-IGF-1 axis dysregulation.