Delayed puberty x ray
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
An X-ray is helpful in the diagnosis of delayed puberty. Findings on an X-ray are specific for bone age. Bone age is used to predict the final adult height of children. There is a strong association between bone age and the puberty onset in boys with developmental disorders. If the difference between measured bone age and chronological age is more than 2 years, it is strongly suggestive of constitutional delay of growth and puberty (CDGP).
X-ray
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- An X-ray is helpful in the diagnosis of delayed puberty. Findings on an X-ray are specific for bone age. Bone age is used to predict the final adult height of children .
- It is one of the first line evaluations in a patient with suspected delayed puberty.
Bone age
- Studies have shown that there is a strong association between bone age and the puberty onset in boys with developmental disorders.[1][2]
- Skeletal maturation and hypothalamus-pituitary-gonadal axis maturation rates are useful in diagnosing delayed puberty. Delayed puberty is related to the skeletal maturation delay that can be caused by various chronic diseases,[3] malnutrition,[4] hypothyroidism,[5] constitutional delay of growth,[6] and growth hormone (GH) deficiency.[7]
- Bone age is measured by studying X-ray of the left hand and wrist. Greulich and Pyle Atlas may be used to interpret the findings.[8][9]
- If the difference between measured bone age and chronological age is more than 2 years, it is strongly diagnostic of constitutional delay of growth and puberty (CDGP).
- The metaphysis of the patients with delayed puberty usually takes more time to mature than the normal population. This results in the final adult height slightly more than the final adult height of a normal individual. If the bone age shows the 4 years difference, it may reflect an additional increase of 8 cm in the final adult height of the patient. Final adult height can be calculated through Bayley-Pinneau tables.[10][11]
References
- ↑ Flor-Cisneros A, Leschek EW, Merke DP, Barnes KM, Coco M, Cutler GB, Baron J (2004). "In boys with abnormal developmental tempo, maturation of the skeleton and the hypothalamic-pituitary-gonadal axis remains synchronous". J. Clin. Endocrinol. Metab. 89 (1): 236–41. doi:10.1210/jc.2002-021954. PMID 14715856.
- ↑ Flor-Cisneros A, Roemmich JN, Rogol AD, Baron J (2006). "Bone age and onset of puberty in normal boys". Mol Cell Endocrinol. 254-255: 202–6. doi:10.1016/j.mce.2006.04.008. PMC 1586226. PMID 16837127.
- ↑ Kulin HE, Bwibo N, Mutie D, Santner SJ (1982). "The effect of chronic childhood malnutrition on pubertal growth and development". Am. J. Clin. Nutr. 36 (3): 527–36. PMID 7113957.
- ↑ Alvear J, Artaza C, Vial M, Guerrero S, Muzzo S (1986). "Physical growth and bone age of survivors of protein energy malnutrition". Arch. Dis. Child. 61 (3): 257–62. PMC 1777696. PMID 3083790.
- ↑ Pantsiouou S, Stanhope R, Uruena M, Preece MA, Grant DB (1991). "Growth prognosis and growth after menarche in primary hypothyroidism". Arch. Dis. Child. 66 (7): 838–40. PMC 1793266. PMID 1863095.
- ↑ Sedlmeyer IL, Palmert MR (2002). "Delayed puberty: analysis of a large case series from an academic center". J. Clin. Endocrinol. Metab. 87 (4): 1613–20. doi:10.1210/jcem.87.4.8395. PMID 11932291.
- ↑ Tanner JM, Whitehouse RH (1975). "A note on the bone age at which patients with true isolated growth hormone deficiency enter puberty". J. Clin. Endocrinol. Metab. 41 (4): 788–90. doi:10.1210/jcem-41-4-788. PMID 170299.
- ↑ Palmert, Mark R.; Dunkel, Leo (2012). "Delayed Puberty". New England Journal of Medicine. 366 (5): 443–453. doi:10.1056/NEJMcp1109290. ISSN 0028-4793.
- ↑ Manzoor Mughal A, Hassan N, Ahmed A (2014). "The applicability of the Greulich & Pyle Atlas for bone age assessment in primary school-going children of Karachi, Pakistan". Pak J Med Sci. 30 (2): 409–11. PMC 3999020. PMID 24772153.
- ↑ Wit JM, Rekers-Mombarg LT (2002). "Final height gain by GH therapy in children with idiopathic short stature is dose dependent". J. Clin. Endocrinol. Metab. 87 (2): 604–11. doi:10.1210/jcem.87.2.8225. PMID 11836292.
- ↑ BAYLEY N, PINNEAU SR (1952). "Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards". J. Pediatr. 40 (4): 423–41. PMID 14918032.