Delayed puberty x ray: Difference between revisions
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==Overview== | ==Overview== | ||
An [[X-ray]] may be helpful in the [[diagnosis]] of delayed [[puberty]]. Findings on an [[X-ray]] are specific to measuring [[bone age]]. [[Bone age]] may be used to predict the | An [[X-ray]] may be helpful in the [[diagnosis]] of delayed [[puberty]]. Findings on an [[X-ray]] are specific to measuring [[bone age]]. [[Bone age]] may be used to predict the final adult height of children. Studies have shown that there is a strong association between [[bone age]] and the initiation of [[puberty]] in boys involved in [[developmental disorders]]. If the difference between measured [[bone age]] and chronological age is more than 2 years, it will strongly diagnostic of [[Constitutional delay of puberty|constitutional delay of growth and puberty (CDGP)]]. | ||
==X-ray== | ==X-ray== | ||
{| align="right" | {| align="right" | ||
| [[Image:Delayed-bone-age.jpg|300px|thumbnail|16 years old girl with growth hormone insufficiency, Case courtesy of Dr Aneta Kecler-Pietrzyk, <ref name=Delayed puberty"https://radiopaedia.org/">Radiopaedia.org. From the case <"https://radiopaedia.org/cases/53554">rID: 53554</ref>]] | | [[Image:Delayed-bone-age.jpg|300px|thumbnail|16 years old girl with growth hormone insufficiency, Case courtesy of Dr Aneta Kecler-Pietrzyk, <ref name=Delayed puberty"https://radiopaedia.org/">Radiopaedia.org. From the case <"https://radiopaedia.org/cases/53554">rID: 53554<nowiki></ref></nowiki>]] | ||
|} | |} | ||
An [[X-ray]] may be helpful in the [[diagnosis]] of delayed [[puberty]]. Findings on an [[X-ray]] are specific to measuring [[bone age]]. [[Bone age]] may be used to predict the children final adult height. | An [[X-ray]] may be helpful in the [[diagnosis]] of delayed [[puberty]]. Findings on an [[X-ray]] are specific to measuring [[bone age]]. [[Bone age]] may be used to predict the children final adult height. | ||
It is on the first line | It is on the first line evaluation of the patient with suspicious delayed [[puberty]]. | ||
=== Bone age === | === Bone age === | ||
* Studies have shown that there is strong association between [[bone age]] and the initiation of [[puberty]] in boys involved in [[developmental disorders]].<ref name="pmid14715856">{{cite journal |vauthors=Flor-Cisneros A, Leschek EW, Merke DP, Barnes KM, Coco M, Cutler GB, Baron J |title=In boys with abnormal developmental tempo, maturation of the skeleton and the hypothalamic-pituitary-gonadal axis remains synchronous |journal=J. Clin. Endocrinol. Metab. |volume=89 |issue=1 |pages=236–41 |year=2004 |pmid=14715856 |doi=10.1210/jc.2002-021954 |url=}}</ref><ref name="pmid16837127">{{cite journal| author=Flor-Cisneros A, Roemmich JN, Rogol AD, Baron J| title=Bone age and onset of puberty in normal boys. | journal=Mol Cell Endocrinol | year= 2006 | volume= 254-255 | issue= | pages= 202-6 | pmid=16837127 | doi=10.1016/j.mce.2006.04.008 | pmc=1586226 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16837127 }}</ref> | * Studies have shown that there is a strong association between [[bone age]] and the initiation of [[puberty]] in boys involved in [[developmental disorders]].<ref name="pmid14715856">{{cite journal |vauthors=Flor-Cisneros A, Leschek EW, Merke DP, Barnes KM, Coco M, Cutler GB, Baron J |title=In boys with abnormal developmental tempo, maturation of the skeleton and the hypothalamic-pituitary-gonadal axis remains synchronous |journal=J. Clin. Endocrinol. Metab. |volume=89 |issue=1 |pages=236–41 |year=2004 |pmid=14715856 |doi=10.1210/jc.2002-021954 |url=}}</ref><ref name="pmid16837127">{{cite journal| author=Flor-Cisneros A, Roemmich JN, Rogol AD, Baron J| title=Bone age and onset of puberty in normal boys. | journal=Mol Cell Endocrinol | year= 2006 | volume= 254-255 | issue= | pages= 202-6 | pmid=16837127 | doi=10.1016/j.mce.2006.04.008 | pmc=1586226 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16837127 }}</ref> | ||
* | * It is suggested that skeletal [[maturation]] and [[hypothalamus]]-[[pituitary]]-[[gonadal]] axis [[maturation]] rates are relevant to each other. Delayed [[puberty]] is related to the skeletal [[maturation]] delay, that can be caused by various diseases, such as [[chronic diseases]]<ref name="pmid7113957">{{cite journal |vauthors=Kulin HE, Bwibo N, Mutie D, Santner SJ |title=The effect of chronic childhood malnutrition on pubertal growth and development |journal=Am. J. Clin. Nutr. |volume=36 |issue=3 |pages=527–36 |year=1982 |pmid=7113957 |doi= |url=}}</ref>, [[malnutrition]]<ref name="pmid3083790">{{cite journal |vauthors=Alvear J, Artaza C, Vial M, Guerrero S, Muzzo S |title=Physical growth and bone age of survivors of protein energy malnutrition |journal=Arch. Dis. Child. |volume=61 |issue=3 |pages=257–62 |year=1986 |pmid=3083790 |pmc=1777696 |doi= |url=}}</ref>, [[hypothyroidism]]<ref name="pmid1863095">{{cite journal |vauthors=Pantsiouou S, Stanhope R, Uruena M, Preece MA, Grant DB |title=Growth prognosis and growth after menarche in primary hypothyroidism |journal=Arch. Dis. Child. |volume=66 |issue=7 |pages=838–40 |year=1991 |pmid=1863095 |pmc=1793266 |doi= |url=}}</ref>, [[Constitutional delay of puberty|constitutional delay of growth]]<ref name="pmid11932291">{{cite journal |vauthors=Sedlmeyer IL, Palmert MR |title=Delayed puberty: analysis of a large case series from an academic center |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=4 |pages=1613–20 |year=2002 |pmid=11932291 |doi=10.1210/jcem.87.4.8395 |url=}}</ref>, and [[Growth hormone|growth hormone (GH)]] deficiency<ref name="pmid170299">{{cite journal |vauthors=Tanner JM, Whitehouse RH |title=A note on the bone age at which patients with true isolated growth hormone deficiency enter puberty |journal=J. Clin. Endocrinol. Metab. |volume=41 |issue=4 |pages=788–90 |year=1975 |pmid=170299 |doi=10.1210/jcem-41-4-788 |url=}}</ref>. | ||
* For measuring [[bone age]] by means of [[X-ray]], the left hand and [[wrist]] have to be studied. Greulich and Pyle Atlas may be used to interpret the findings.<ref name="PalmertDunkel2012">{{cite journal|last1=Palmert|first1=Mark R.|last2=Dunkel|first2=Leo|title=Delayed Puberty|journal=New England Journal of Medicine|volume=366|issue=5|year=2012|pages=443–453|issn=0028-4793|doi=10.1056/NEJMcp1109290}}</ref><ref name="pmid24772153">{{cite journal| author=Manzoor Mughal A, Hassan N, Ahmed A| title=The applicability of the Greulich & Pyle Atlas for bone age assessment in primary school-going children of Karachi, Pakistan. | journal=Pak J Med Sci | year= 2014 | volume= 30 | issue= 2 | pages= 409-11 | pmid=24772153 | doi= | pmc=3999020 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24772153 }}</ref> | * For measuring [[bone age]] by means of [[X-ray]], the left hand and [[wrist]] have to be studied. Greulich and Pyle Atlas may be used to interpret the findings.<ref name="PalmertDunkel2012">{{cite journal|last1=Palmert|first1=Mark R.|last2=Dunkel|first2=Leo|title=Delayed Puberty|journal=New England Journal of Medicine|volume=366|issue=5|year=2012|pages=443–453|issn=0028-4793|doi=10.1056/NEJMcp1109290}}</ref><ref name="pmid24772153">{{cite journal| author=Manzoor Mughal A, Hassan N, Ahmed A| title=The applicability of the Greulich & Pyle Atlas for bone age assessment in primary school-going children of Karachi, Pakistan. | journal=Pak J Med Sci | year= 2014 | volume= 30 | issue= 2 | pages= 409-11 | pmid=24772153 | doi= | pmc=3999020 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24772153 }}</ref> | ||
* If the difference between measured [[bone age]] and chronological age is more than 2 years, it will strongly diagnostic of [[Constitutional delay of puberty|constitutional delay of growth and puberty (CDGP)]]. | * If the difference between measured [[bone age]] and chronological age is more than 2 years, it will strongly diagnostic of [[Constitutional delay of puberty|constitutional delay of growth and puberty (CDGP)]]. | ||
* If the [[bone age]] shows the 4 years delay, it may reflect | * If the [[bone age]] shows the 4 years delay, it may reflect an 8 cm more final adult height in the patient. Final adult height can be concluded through Bayley-Pinneau tables.<ref name="pmid11836292">{{cite journal |vauthors=Wit JM, Rekers-Mombarg LT |title=Final height gain by GH therapy in children with idiopathic short stature is dose dependent |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=2 |pages=604–11 |year=2002 |pmid=11836292 |doi=10.1210/jcem.87.2.8225 |url=}}</ref><ref name="pmid14918032">{{cite journal |vauthors=BAYLEY N, PINNEAU SR |title=Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards |journal=J. Pediatr. |volume=40 |issue=4 |pages=423–41 |year=1952 |pmid=14918032 |doi= |url=}}</ref> | ||
==References== | ==References== | ||
Revision as of 15:15, 3 October 2017
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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 may be helpful in the diagnosis of delayed puberty. Findings on an X-ray are specific to measuring bone age. Bone age may be used to predict the final adult height of children. Studies have shown that there is a strong association between bone age and the initiation of puberty in boys involved in developmental disorders. If the difference between measured bone age and chronological age is more than 2 years, it will strongly diagnostic of constitutional delay of growth and puberty (CDGP).
X-ray
 <ref> tag</nowiki> |
An X-ray may be helpful in the diagnosis of delayed puberty. Findings on an X-ray are specific to measuring bone age. Bone age may be used to predict the children final adult height.
It is on the first line evaluation of the patient with suspicious delayed puberty.
Bone age
- Studies have shown that there is a strong association between bone age and the initiation of puberty in boys involved in developmental disorders.[1][2]
- It is suggested that skeletal maturation and hypothalamus-pituitary-gonadal axis maturation rates are relevant to each other. Delayed puberty is related to the skeletal maturation delay, that can be caused by various diseases, such as chronic diseases[3], malnutrition[4], hypothyroidism[5], constitutional delay of growth[6], and growth hormone (GH) deficiency[7].
- For measuring bone age by means of X-ray, the left hand and wrist have to be studied. 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 will strongly diagnostic of constitutional delay of growth and puberty (CDGP).
- If the bone age shows the 4 years delay, it may reflect an 8 cm more final adult height in the patient. Final adult height can be concluded 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.