Delayed puberty Flashcards
What is the definition of delayed puberty?
Absence of pubertal development by 14 years of age in females, 15 years in males
What are the 3 major groups of delayed puberty?
- Constitutional delay of growth and puberty/ familial
- Low gonadotrophin secretion (hypogonadotropic hypogonadism)
- High gonadotrophin secretion (hypergonadotropic hypogonadism)
What is the most common cause of delayed puberty?
Constitutional/familial
What are 6 causes of delayed puberty in which there is low gonadotrophin secretion (hypogonadotropic hypogonadism)?
- Systemic disease: CF, asthma, Crohn’s, organ failure, anorexia, starvation, excess physical training
- Pituitary dysfunction
- Isolated gonadotrophin or growth hormone deficiency
- Intracranial tumours (including craniopharyngioma)
- Kallmann syndrome (luteinising hormone-releasing hormone deficiency and inability to smell)
- Acquired hypothyroidism
What are 7 types of systemic disease that can cause delayed puberty with low gonadotrophin secretion (hypogonadotropic hypogonadism)?
- Cystic fibrosis
- Severe asthma
- Crohn’s disease
- Organ failure
- Anorexia nervosa
- Starvation
- Excess physical training
What are 9 causes of delayed puberty with high gonadotrophin secretion (hypergonadotropic hypogonadism)?
- Klinefelter syndrome (47, XXY)
- Turner syndrome (45, XO)
- Steroid hormone enzyme deficiencies
- Postsurgery damage to gonads
- Chemotherapy damage to gonads
- Radiotherapy damage to gonads
- Gonad trauma
- Torsion of testis
- Autoimmune disorder
In which gender is delayed puberty more common and why?
Males due to relative insensitivity of testes to gonadotropin secretion
What are 4 common physical features of physiological/familial delayed puberty?
- Delayed sexual changes compared with peers
- Bone age shows moderate delay
- Legs long in comparison to back
- Target height reached eventually as growth will continue for longer than in peers
Do children with familial/constitutional delayed puberty reach their target height?
Yes - growth just continues for longer than in their peers
What are 3 effects that delayed puberty may have at school?
- Psychological upset from teasing
- Poor self-esteem
- Disadvantage in competitive sport
What are 2 key things to do in the assessment of delayed puberty in boys?
- Pubertal staging, especially testicular volume
- Indentification of long-term systemic disorders
What are 3 aspects of management of delayed puberty in males?
- Reassurance normal puberty will occur - treatment not usually required
- If treatment required, = oral oxandrolone (androgenic anabolic steroid)
- Older boys - low-dose intramuscular testosterone
How does oxandrolone work to treat delayed puberty in younger males?
Weakly androgenic anabolic steroid, will induce some catch-up growth but not secondary sexual characteristics
How does IM testosterone work to treat delayed puberty in older boys?
Accelerates growth as well as inducing secondary sexual characteristics
What are 3 things to consider for assessment of girls with delayed puberty?
Less common so important to exclude organic cause
- Karyotyping should be performed to identify Turner syndrome
- Thyroid and sex steroid hormones should be measured
- Consider possibility of eating disorder and pituitary pathology
