Edit concept Question Editor Create issue ticket

Puberty Delayed


Presentation

  • Delayed puberty in boys is said to be present if there are no signs of puberty by age 14 Arrested (suspended) puberty is present if puberty started normally but then doesn't progress. In young females, this includes when periods start and then stop.[headsmart.org.uk]
  • The peak growth spurt and other changes such as voice breaking, muscle bulking and facial hair growth are not usually present for another two years.[gponline.com]
  • Low gonadotropins may be present in isolated gonadotropin deficiency or combined genetic syndrome such as Kallman's Syndrome but also due to intra cranial lesions.[pathology.leedsth.nhs.uk]
  • A suggested algorithm for the evaluation of the child with pubertal delay is presented in Figure 2.[kallmannsyndrome.wordpress.com]
Fatigue
  • ., was beset by depression, fatigue, weight gain and sexual dysfunction, and doctors, who for years gave him medication for his individual complaints, never looking at the whole picture.[nytimes.com]
  • […] history can provide clues as to the cause of delayed puberty. [7] Delayed growth and puberty can be the first signs of severe chronic illnesses such as metabolic disorders including inflammatory bowel disease and hypothyroidism. [7] Symptoms such as fatigue[en.wikipedia.org]
Bulimia
  • Low body fat may be found in girls who: Are extremely athletic (especially competitive swimmers, ballet dancers and gymnasts) Practice extreme dieting or have an eating disorder such as anorexia or bulimia Have a chronic condition that inhibits growth[rileychildrens.org]
  • […] level by which the gonads are affected with younger patients at a lower risk of negative reproductive effects. [31] Excessive physical exercise and physical stress, especially in athletes can also delay pubertal onset. [32] Eating disorders such as bulimia[en.wikipedia.org]
High Arched Palate
  • Most girls with Turner syndrome are very short for their age and may have distinctive physical features like webbing of the neck, a high-arched palate or arms that bend outward when extended.[rileychildrens.org]
Small Hand
  • "There's a small handful of genes that have been implicated in early or late puberty so far. There will undoubtedly be more. "Our discovery is exciting though because it reveals a novel mechanism that we didn't know about before."[bbc.com]

Workup

  • […] healthy physical development. [2] Delay of puberty may also occur due to various causes such as malnutrition, various systemic diseases, or defects of the reproductive system ( hypogonadism ) or the body's responsiveness to sex hormones. [2] Initial workup[en.wikipedia.org]

Treatment

  • Treatment The aim of treatment: Development of age-appropriate secondary sex characteristics . Induction of a growth spurt without inducing premature epiphyseal closure. Achievement of normal muscle mass and bone mineral density for age.[slideshare.net]
  • Height SDS, CA-BA, and PAH during follow-up in 96 boys with CDGP, who received oral TU treatment. Measurements prior to oral TU treatment (black circles), during oral TU treatment (red circles), and after oral TU treatment (blue circles).[academic.oup.com]
  • Treatments Treatments Treatment for delayed puberty includes: Testosterone therapy for boys. In some cases, a doctor may prescribe a few monthly testosterone injections to stimulate puberty in boys.[rileychildrens.org]
  • Once the process starts, it usually progresses on its own with no further treatment, experts said. Continue reading the main story[nytimes.com]
  • Does my child need treatment for delayed puberty? What are the options for treatment? What are the risks and benefits of each treatment option? How long will my child need treatment? Edited: November 2017[hormone.org]

Prognosis

  • Prognosis The majority of cases of delayed puberty do not require treatment. In other cases, treatment of the underlying cause or hormonal replacement will be sufficient to solve the problem without any lasting side effects.[qldpaedendocrinology.com.au]
  • Prognosis and treatment The treatment of delayed puberty depends on the specific cause, and in some cases treatment is not necessary.[britannica.com]
  • Despite an obvious cause, pubertal assessment is necessary as active treatment of the delay in growth and puberty can improve the growth prognosis, reduce long-term risk of osteoporosis and boost self-esteem, so a referral is beneficial.[gponline.com]
  • This is defined as physiologic hypogonadotropic hypogonadism. [8] Extremely elevated LH and FSH levels are indicative of gonadal dysfunction (ie, pathologic hypergonadotropic hypogonadism) and convey a poor prognosis for spontaneous pubertal development[emedicine.medscape.com]

Etiology

  • The Authors discuss about etiology, diagnostic testing and therapeutic approach in these conditions. The majority of children with delayed puberty are males that have only a constitutional delay of growth and puberty.[ncbi.nlm.nih.gov]
  • Published on Sep 30, 2016 Dr Aftab Ahmad JNMC AMU Aligarh Delayed puberty , etiology , diagnostic approach 1. Delayed puberty , Etiology , Diagnostic approach By – Dr . Aftab Ahmad Mod – Dr. Jatin 2.[slideshare.net]
  • Etiology of short stature in children. J Coll Physicians Surg Pak. 2008 Aug. 18(8):493-7. [Medline]. Rohani F, Alai MR, Moradi S, Amirkashani D. Evaluation of near final height in boys with constitutional delay in growth and puberty.[emedicine.medscape.com]

Epidemiology

  • Sex Although the epidemiologic data indicate that all variants of normal growth are twice as common in boys as in girls, referrals for short stature reflect an even more divergent sex ratio.[emedicine.medscape.com]
  • Epidemiology Exact prevalence of delayed puberty is not known.[patient.info]
  • "Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms". Human Reproduction Update (Review). 20 (4): 582–93. doi : 10.1093/humupd/dmu007. PMID 24619876.[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Lewkowitz-Shpuntoff HM, Hughes VA, Plummer L, et al ; Olfactory phenotypic spectrum in idiopathic hypogonadotropic hypogonadism: pathophysiological and genetic implications. J Clin Endocrinol Metab. 2012 Jan97(1):E136-44. doi: 10.1210/jc.2011-2041.[patient.info]
  • Pathophysiology Constitutional growth delay is a global delay in development that affects every organ system.[emedicine.medscape.com]

Prevention

  • […] from sending the “start puberty” signal conditions that prevent the ovaries or testes from being able to respond to the “start puberty” signal certain genetic conditions, such as Klinefelter’s syndrome in boys and Turner syndrome in girls 3.[childrenshospital.org]
  • Illnesses such as brain tumors, hypothyroidism or anorexia may be preventing the brain from stimulating the gonads to produce the hormones needed.[newportchildren.com]
  • However, short courses of sex hormones may be used to allow individuals to catch up with their peers and prevent psychological and emotional sequelae.[patient.info]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!