Delayed puberty natural history, complications and prognosis: Difference between revisions
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=== Prognosis === | === Prognosis === | ||
* The major determinant of delayed [[puberty]] [[prognosis]] is underlying [[Comorbidity|co-morbidity]], not the [[disease]] itself. | * The major determinant of delayed [[puberty]] [[prognosis]] is underlying [[Comorbidity|co-morbidity]], not the [[disease]] itself. | ||
* [[Constitutional delay of puberty|Constitutional delay of growth and puberty (CDGP)]] has an excellent [[prognosis]]. The [[puberty]] and final height in these patients will occur normal in the future, without any [[Hormone replacement therapy|hormone replacement]]. | * [[Constitutional delay of puberty|Constitutional delay of growth and puberty (CDGP)]] has an excellent [[prognosis]]. The [[puberty]] and final height in these patients will occur normal in the future, without any [[Hormone replacement therapy|hormone replacement]] therapy. | ||
* Patients with benign [[Comorbidity|co-morbidity]] induced delayed [[puberty]], like delayed [[puberty]] due to [[lifestyle]] disorders ([[malnutrition]] or excessive [[exercise]]) or mild [[chronic diseases]], can completely gain their normal [[puberty]] characteristics after suitable treatment of underlying diseases. | * Patients with benign [[Comorbidity|co-morbidity]] induced delayed [[puberty]], like delayed [[puberty]] due to [[lifestyle]] disorders ([[malnutrition]] or excessive [[exercise]]) or mild [[chronic diseases]], can completely gain their normal [[puberty]] characteristics after suitable treatment of underlying diseases. | ||
* Permanent causes of delayed [[puberty]], such as idiopathic [[hypogonadotropic hypogonadism]], [[genetic diseases]], [[chromosomal]] disorders (e.g.,[[Turner's syndrome]] or [[Klinefelter's syndrome]]), or [[pituitary]] surgical procedures (e.g., [[craniopharyngioma]] treatment) need lifelong [[hormone replacement therapy]].<ref name="urlDelayed puberty Prognosis - Epocrates Online">{{cite web |url=https://online.epocrates.com/diseases/112651/Delayed-puberty/Prognosis |title=Delayed puberty Prognosis - Epocrates Online |format= |work= |accessdate=}}</ref> | * Permanent causes of delayed [[puberty]], such as idiopathic [[hypogonadotropic hypogonadism]], [[genetic diseases]], [[chromosomal]] disorders (e.g.,[[Turner's syndrome]] or [[Klinefelter's syndrome]]), or [[pituitary]] surgical procedures (e.g., [[craniopharyngioma]] treatment) need lifelong [[hormone replacement therapy]].<ref name="urlDelayed puberty Prognosis - Epocrates Online">{{cite web |url=https://online.epocrates.com/diseases/112651/Delayed-puberty/Prognosis |title=Delayed puberty Prognosis - Epocrates Online |format= |work= |accessdate=}}</ref> | ||
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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
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. If the testicular enlargement or breast development has not occurred at an mean age of puberty in population plus 2-2.5 standard deviation (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. The main complications of delayed puberty are osteoporosis, psychological problems, polycythemia, and irritation from hormonal gels and patches. The major determinant of delayed puberty prognosis is underlying co-morbidity, not the disease itself. Constitutional delay of growth and puberty (CDGP) has an excellent prognosis. The puberty and final height in these patients will be normal in the future, without any hormone replacement therapy.
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.
- 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.
- If left untreated, all of patients with constitutional delay of puberty and growth may progress to develop normal puberty and growth.
- All patients with delayed puberty have to be precisely monitored until normal puberty and growth become accomplished. It may take about 2-5 years. Final height can be measured by adding or subtracting 2.5 inches to the average height of parents. On average, puberty is accompanied by gaining 25 cm of height in girls and 30 cm in boys.
Delayed puberty in boys is identified as:[1]
- No sign of testicular enlargement by 14 years of the age
OR
- No pubic hair by 15 years of age
OR
Delayed puberty in girls is identified as:[1]
- No signs of breast development by 14 years of age
OR
- No pubic hair by 14 years of age
OR
- No breast development to adult type 5 years after puberty beginning
OR
- No menstruation periods by 16 years of age
Normal puberty timing
Approximate mean ages for onset of various pubertal changes are as follows: Developmental changes during puberty in girls occur over a period of 3-5 years, usually between 9 and 14 years of age. They include the occurrence of secondary sex characteristics beginning with breast development, the adolescent growth spurt, the onset of menarche (not correspond to the end of puberty), and the acquisition of fertility, as well as profound psychological modifications.[2]
North American, Indo-Iranian (India, Iran) and European girls
- Thelarche: 10 years and 5 months of age
- Pubarche: 11 years of age
- Growth spurt: 10-12.5 years of age
- Menarche: 12.5 years of age
- Adult height reached: 14.5 years of age
North American, Indo-Iranian (India, Iran) and European boys
- Testicular enlargement: 11.5 years of age
- Pubic hair: 12 years of age
- Growth spurt: 12.5–15 years of age
- Completion of growth: 17.5 years of age
Complications
Osteoporosis
- Lack of estrogen and other sex steroids can cause decreasing the bone mineralization and osteoporosis.[3]
- The amount of bone mass that every person has gained during the puberty is the key factor not to involve in osteoporosis.[3]
- Although the patients involved in delayed puberty would gain their normal sexual maturation, but they will experience a decreased peak bone mass if they left untreated.[4]
Psychological problems[5]
- Delayed puberty may threatened the final height and also adult phenotype, every men and women expect to experience during adulthood.
- Delayed or absent secondary sexual characteristics may encounter the patient's self-esteem with trouble and influence people interpersonal relationships.
- Patients with a disease resulting in anorchia have to be counseled about testicular prosthesis.
Polycythemia
- The use of testosterone in treatment of delayed puberty can cause RBCs overproduction which can lead to increasing the hematocrit.
Irritation from gels and patches
- Therapeutic hormonal gels and patches that are frequently used in delayed puberty can cause allergic reactions and irritation.
Prognosis
- The major determinant of delayed puberty prognosis is underlying co-morbidity, not the disease itself.
- Constitutional delay of growth and puberty (CDGP) has an excellent prognosis. The puberty and final height in these patients will occur normal in the future, without any hormone replacement therapy.
- Patients with benign co-morbidity induced delayed puberty, like delayed puberty due to lifestyle disorders (malnutrition or excessive exercise) or mild chronic diseases, can completely gain their normal puberty characteristics after suitable treatment of underlying diseases.
- Permanent causes of delayed puberty, such as idiopathic hypogonadotropic hypogonadism, genetic diseases, chromosomal disorders (e.g.,Turner's syndrome or Klinefelter's syndrome), or pituitary surgical procedures (e.g., craniopharyngioma treatment) need lifelong hormone replacement therapy.[6]
References
- ↑ 1.0 1.1 "Complications of puberty - Ireland's Health Service".
- ↑ Invalid
<ref>tag; no text was provided for refs named:0 - ↑ 3.0 3.1 Gilsanz, Vicente; Chalfant, James; Kalkwarf, Heidi; Zemel, Babette; Lappe, Joan; Oberfield, Sharon; Shepherd, John; Wren, Tishya; Winer, Karen (2011). "Age at Onset of Puberty Predicts Bone Mass in Young Adulthood". The Journal of Pediatrics. 158 (1): 100–105.e2. doi:10.1016/j.jpeds.2010.06.054. ISSN 0022-3476.
- ↑ Finkelstein JS, Neer RM, Biller BM, Crawford JD, Klibanski A (1992). "Osteopenia in men with a history of delayed puberty". N. Engl. J. Med. 326 (9): 600–4. doi:10.1056/NEJM199202273260904. PMID 1734250.
- ↑ Lee PD, Rosenfeld RG (1987). "Psychosocial correlates of short stature and delayed puberty". Pediatr. Clin. North Am. 34 (4): 851–63. PMID 3302895.
- ↑ "Delayed puberty Prognosis - Epocrates Online".