We retrospectively evaluated hand x-rays of children (aged 1- 14 years) referred to our department from the outpatient clinics (in particular from the endocrinology) using G & P atlas or Hand bone age (or estimation of bone ages in the last 2 years. Bone age was determined using the G & P atlas or Hand bone age (VG & OR, Springer). Bone age was considered abnormal and increased if more than 2 years than the chronological age to avoid any normal variance in age for the region. Causes were documented by reviewing clinical and laboratory tests and the affected gender.