Please register or login to view the chart

Delayed puberty -Quick review chart

Delayed puberty Hypothalamus starts pulsatile GNRG which stimulates pulsatile release of FSH , LH from anterior pituitary. FSH / LH stimulates germ cell maturation , LH produces oestrogen in in girls and testosterone in boys.

 

Early changes by age 10-13 Girls -budding of breasts , then pubic hair and menstruation starting between 11-14 yrs Girls – growth spurt happens earlier in puberty and about same time as onset of breast development , growth slows down after 1s period Boys- testicular enlargement ( 3-4 mL ) and then pubic hair ( 9-14 yrs ), axillary , facial hairs , deepening of voice Boys grow slowly at start of puberty , accelerate mid puberty and

 

Delayed puberty – about 95 % of G’s/B’s have commenced puberty by 13 and 14 yrs

 

Most common cause in more than 50 % of cases is a constitutional delay – Most common cause is a constitutional delay ( Constitutional delay of growth and development CDGP ) which runs in families Functional delay may also happen due to chronic illness ( systemic illnesses as CKD , CCF , chronic lung disease etc ) , excessive physical exercise , malnutrition , eating disorders , prolonged stress Hypogonadotrophic hypogonadism ie defect in hypothlamo-pituitary region. Partial or complete GNRH deficiency. Causes can be idiopathic or congenital ( Kallman syndrome – consider if patient c/o anosmia) Acquired causes may be due to drugs , infiltrative , infectious pituitary lesions , hyperprolactinemia , encephalic trauma , pituitary /brain radiation ,alcohol / drug abuse , conditions as haemochromatosis , sarcoidosis 
 Hyper gonadotrophic hypogonadism -primary gonadal failure ( E.g congenital disorders as cryptorchidism , chromosomal disorders Klinefelters , Turners , acquired causes as testicular torsion , chemotherapy , infections , testicular or ovarian surgery ) Both ( secondary to radio / chemotherpay ) Unclassified

Assessment – family history -pubertal timing ( genetic , chromosomal problems ) onset , progression body odour , acne , breast / testicular development history suggestive of any previous sig illness- chemotherapy , radiation therapy orchidopexy , treatment with exogenous steroids for e.g for asthma , nephrotic syndrome eating disorders , recent weight loss h/o viral infections as mumps , lack of smell

Initial testing – Primary 
Care FBC / UE / LFT / TFT , Coeliac screen Hormone profile LH , FSH , FT4 , TSH , prolactin , Estradiol , testosterone Bone age ( X Ray of wrist non dominant hand )

RESOURCES

Find Tanner staging and testicular measurement aid in this useful work from Paediatric Pearls Pubertal-stages-and-timings.pdf (paediatricpearls.co.uk)

REFERENCES

  1. Delayed puberty Kingston Hospital NHS Trust Delayed Puberty – Kingston Hospital
  2. Wei C, Davis N, Honour J, Crowne E. The investigation of children and adolescents with abnormalities of pubertal timing. Ann Clin Biochem. 2017 Jan;54(1):20-32. doi: 10.1177/0004563216668378. Epub 2016 Sep 28. PMID: 27555666.
  3. Traggiai C, Stanhope R. Delayed puberty. Best Pract Res Clin Endocrinol Metab. 2002 Mar;16(1):139-51. doi: 10.1053/beem.2001.0186. PMID: 11987904. ( Abstract )
  4. Dye AM, Nelson GB, Diaz-Thomas A. Delayed Puberty. Pediatr Ann. 2018 Jan 1;47(1):e16-e22. doi: 10.3928/19382359-20171215-01. PMID: 29323692. ( Abstract )
  5. Fraietta, Renato et al. “Hypogonadotropic hypogonadism revisited.” Clinics (Sao Paulo, Brazil) vol. 68 Suppl 1,Suppl 1 (2013): 81-8. doi:10.6061/clinics/2013(sup01)09
  6. Hormones and me delayed puberty *mer5334-saizen-hormones-and-me-delayed-puberty-v3.pdf (d192ha6kdpe15x.cloudfront.net)

Share

Related Charts:

Add Your Comments

Your email address will not be published.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

A4 Medicine  - Search Less and Learn More

Welcome to the A4 medicine community where we are constantly working to provide exceptional educational material to primary health care professionals. Subscribe to our website for complete access to our A4 Charts. They are aesthetically designed charts that contain 300 (plus and adding) common and complex medical conditions with the all information required for primary care in one single page that can help you in consultation/practice and exam.

Additionally, you will get complete access for our Learn From Experts : A4 Webinar Series in which domain experts share the video explainer presentation on one medical condition in one hour for the primary care. And you will also get a hefty discount on our publications and upcoming digital products.

We are giving a lifetime flat 30% discount to our first thousand users, discount code already applied to checkout.