Delayed puberty natural history, complications and prognosis: Difference between revisions
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=== Natural history === | === Natural history === | ||
* The symptoms of puberty usually develop between 8 and 13 in girls and between 9 and 14 in boys, and start with symptom of breast development in girls and testicular enlargement in boys.<ref name="pmid10414639">{{cite journal |vauthors=Blondell RD, Foster MB, Dave KC |title=Disorders of puberty |journal=Am Fam Physician |volume=60 |issue=1 |pages=209–18, 223–4 |year=1999 |pmid=10414639 |doi= |url=}}</ref> | * The symptoms of puberty usually develop between 8 and 13 in girls and between 9 and 14 in boys, and start with symptom of breast development in girls and testicular enlargement in boys.<ref name="pmid10414639">{{cite journal |vauthors=Blondell RD, Foster MB, Dave KC |title=Disorders of puberty |journal=Am Fam Physician |volume=60 |issue=1 |pages=209–18, 223–4 |year=1999 |pmid=10414639 |doi= |url=}}</ref> | ||
* If the testicular enlargement or breast development has not occurred at an mean age of puberty in population plus 2-2.5 SD, it will be called delayed puberty. The mean age is depend on various factors, such as race, nutrition, and also socioeconomic status. Recently, the puberty age is decreasing in US and other countries.<ref name="pmid12415029">{{cite journal |vauthors=Sun SS, Schubert CM, Chumlea WC, Roche AF, Kulin HE, Lee PA, Himes JH, Ryan AS |title=National estimates of the timing of sexual maturation and racial differences among US children |journal=Pediatrics |volume=110 |issue=5 |pages=911–9 |year=2002 |pmid=12415029 |doi= |url=}}</ref> | * If the testicular enlargement or breast development has not occurred at an mean age of puberty in population plus 2-2.5 SD, it will be called delayed puberty. The mean age is depend on various factors, such as race, nutrition, and also socioeconomic status. Recently, the puberty age is decreasing in US and other countries.<ref name="pmid12415029">{{cite journal |vauthors=Sun SS, Schubert CM, Chumlea WC, Roche AF, Kulin HE, Lee PA, Himes JH, Ryan AS |title=National estimates of the timing of sexual maturation and racial differences among US children |journal=Pediatrics |volume=110 |issue=5 |pages=911–9 |year=2002 |pmid=12415029 |doi= |url=}}</ref><ref name="pmid12359790">{{cite journal |vauthors=Wu T, Mendola P, Buck GM |title=Ethnic differences in the presence of secondary sex characteristics and menarche among US girls: the Third National Health and Nutrition Examination Survey, 1988-1994 |journal=Pediatrics |volume=110 |issue=4 |pages=752–7 |year=2002 |pmid=12359790 |doi= |url=}}</ref><ref name="pmid20124146">{{cite journal |vauthors=Susman EJ, Houts RM, Steinberg L, Belsky J, Cauffman E, Dehart G, Friedman SL, Roisman GI, Halpern-Felsher BL |title=Longitudinal development of secondary sexual characteristics in girls and boys between ages 91/2 and 151/2 years |journal=Arch Pediatr Adolesc Med |volume=164 |issue=2 |pages=166–73 |year=2010 |pmid=20124146 |pmc=2863107 |doi=10.1001/archpediatrics.2009.261 |url=}}</ref><ref name="pmid19403485">{{cite journal |vauthors=Aksglaede L, Sørensen K, Petersen JH, Skakkebaek NE, Juul A |title=Recent decline in age at breast development: the Copenhagen Puberty Study |journal=Pediatrics |volume=123 |issue=5 |pages=e932–9 |year=2009 |pmid=19403485 |doi=10.1542/peds.2008-2491 |url=}}</ref><ref name="pmid19926714">{{cite journal |vauthors=Sørensen K, Aksglaede L, Petersen JH, Juul A |title=Recent changes in pubertal timing in healthy Danish boys: associations with body mass index |journal=J. Clin. Endocrinol. Metab. |volume=95 |issue=1 |pages=263–70 |year=2010 |pmid=19926714 |doi=10.1210/jc.2009-1478 |url=}}</ref> | ||
* If left untreated, all of patients with constitutional delay of puberty and growth may progress to develop normal puberty and growth. | |||
* If left untreated, | |||
All patients need to be monitored until the pubertal process is complete. Puberty is accompanied by the growth spurt and is typically complete within 2 to 5 years. Growth should be monitored on age- and sex-appropriate growth charts to ensure that the full growth potential is achieved. Puberty contributes 25 cm of height in females and 30 cm in males on average. | All patients need to be monitored until the pubertal process is complete. Puberty is accompanied by the growth spurt and is typically complete within 2 to 5 years. Growth should be monitored on age- and sex-appropriate growth charts to ensure that the full growth potential is achieved. Puberty contributes 25 cm of height in females and 30 cm in males on average. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Natural History, Complications, and Prognosis
Natural history
- The symptoms of puberty usually develop between 8 and 13 in girls and between 9 and 14 in boys, and start with symptom of breast development in girls and testicular enlargement in boys.[1]
- If the testicular enlargement or breast development has not occurred at an mean age of puberty in population plus 2-2.5 SD, it will be called delayed puberty. The mean age is depend on various factors, such as race, nutrition, and also socioeconomic status. Recently, the puberty age is decreasing in US and other countries.[2][3][4][5][6]
- If left untreated, all of patients with constitutional delay of puberty and growth may progress to develop normal puberty and growth.
All patients need to be monitored until the pubertal process is complete. Puberty is accompanied by the growth spurt and is typically complete within 2 to 5 years. Growth should be monitored on age- and sex-appropriate growth charts to ensure that the full growth potential is achieved. Puberty contributes 25 cm of height in females and 30 cm in males on average.
Continued pubertal assessment is best assessed by Tanner staging. [null [26]] [null [27]] Stage 5 is adult for both sexes and indicates completion of the process. Testicular size is documented as a measurement of the longest axis or as the testicular volume using the Prader orchidometer. [null image]
It is not always possible to clarify whether a patient has a permanent defect at initial testing prior to pubertal induction, as the interpretation of the LH-releasing hormone (LHRH) stimulation test is not straightforward. [null [31]] If the diagnosis of a permanent defect is in doubt, endocrine tests should be repeated after completion of growth and puberty to ascertain the need for long-term hormone replacement. [null [32]]
Additional monitoring of patients with an underlying etiology of chromosomal syndromes, tumors, and autoimmune disorders will depend upon the individual condition.
Complications
| [null psychological problems]
Pubertal delay and short stature due to lack of a growth spurt can result in bullying. A delay in treatment can lead to difficulties in interpersonal relationships, and early treatment must therefore be commenced. Patients with anorchia need to be counseled for testicular prosthesis. Those with permanent hypogonadism should receive counseling regarding the lack of fertility. |
low | variable |
| [null skin irritation from gels and patches]
Occurs in up to one third of patients using the patch. |
low | variable |
| [null polycythemia]
This is a particular problem with intramuscular testosterone preparations. The testosterone dose may need to be reduced. |
low | variable |
| [null osteoporosis] [null (view full topic)]
The absence of sex steroids leads to inadequate bone mineralization. This may result in fractures and osteoporosis later in adult life. All patients with permanent hypogonadism require sex-steroid replacement throughout the reproductive period. |
Prognosis
Overall outlook relates to the underlying cause of delayed puberty rather than to the delay itself.
Patients with a temporary delay such as those with constitutional delay in puberty have an excellent prognosis and achieve normal gonadal function postpuberty without testosterone (or estrogen) replacement therapy.
Similarly, patients with a chronic illness, malnutrition, or intense exercise typically recover normal gonadal function after resolution of the illness or exercise.
Patients with a permanent cause such as organic gonadotropin deficiency, Turner syndrome, Klinefelter syndrome, or previous pituitary surgery for a craniopharyngioma require lifelong hormone therapy.
References
- ↑ Blondell RD, Foster MB, Dave KC (1999). "Disorders of puberty". Am Fam Physician. 60 (1): 209–18, 223–4. PMID 10414639.
- ↑ Sun SS, Schubert CM, Chumlea WC, Roche AF, Kulin HE, Lee PA, Himes JH, Ryan AS (2002). "National estimates of the timing of sexual maturation and racial differences among US children". Pediatrics. 110 (5): 911–9. PMID 12415029.
- ↑ Wu T, Mendola P, Buck GM (2002). "Ethnic differences in the presence of secondary sex characteristics and menarche among US girls: the Third National Health and Nutrition Examination Survey, 1988-1994". Pediatrics. 110 (4): 752–7. PMID 12359790.
- ↑ Susman EJ, Houts RM, Steinberg L, Belsky J, Cauffman E, Dehart G, Friedman SL, Roisman GI, Halpern-Felsher BL (2010). "Longitudinal development of secondary sexual characteristics in girls and boys between ages 91/2 and 151/2 years". Arch Pediatr Adolesc Med. 164 (2): 166–73. doi:10.1001/archpediatrics.2009.261. PMC 2863107. PMID 20124146.
- ↑ Aksglaede L, Sørensen K, Petersen JH, Skakkebaek NE, Juul A (2009). "Recent decline in age at breast development: the Copenhagen Puberty Study". Pediatrics. 123 (5): e932–9. doi:10.1542/peds.2008-2491. PMID 19403485.
- ↑ Sørensen K, Aksglaede L, Petersen JH, Juul A (2010). "Recent changes in pubertal timing in healthy Danish boys: associations with body mass index". J. Clin. Endocrinol. Metab. 95 (1): 263–70. doi:10.1210/jc.2009-1478. PMID 19926714.