Delayed puberty medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
{{familytree/start}} | |||
{{familytree | | | | | | | | | A01 | | | | | |A01='''Delayed Puberty'''}} | |||
{{familytree | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | B01 | | | | | |B01='''''Initial assessment'''''}} | |||
{{familytree | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree |boxstyle=text-align: left; | | | | | | | | | B01 | | | | | |B01=• Clinical history <br>• Physical examinations<br>• Pubertal phenotype<br>• Left wrist [[radiograph]] for [[bone age]]}} | |||
{{familytree | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }} | |||
{{familytree | | C01 | | | | | C02 | | | | | C03 |C01='''''Unremarkable'''''|C02='''''Abnormal'''''|C03='''''Chronic disease'''''}} | |||
{{familytree | | |!| | | | | | |!| | | | | | |!| }} | |||
{{familytree |boxstyle=text-align: left; | | D01 | | | | | D02 | | | | | D03 |D01= • Delayed [[puberty]]<br>• Lack of [[growth spurt]]<br>• [[Bone age]] delayed upon chronological age|D02= • Possibility of [[chromosomal disorder]] <br>• [[Bone age]] may delayed |D03= • Chronic disease<br>• Decreased growth rate or [[short stature]]<br>• [[Bone age]] delayed upon chronological age}} | |||
{{familytree | | |!| | | | | | |!| | | | | | |!| }} | |||
{{familytree |boxstyle=text-align: left; | | D01 | | | | | D02 | | | | | D03 |D01='''''Diagnosis: '''''<br>• [[Constitutional delay of puberty|Constitutional delay of growth and puberty (CDGP)]]<br>• [[Gonadotropin]] deficiency<br>• Primary [[gonadal]] failure<br>• Extreme athletic exercise|D02='''''Diagnosis: '''''<br> Girls:<br>• [[Turner syndrome]]<br> Boys:<br>• [[Klinefelter syndrome]]|D03='''''Diagnosis: '''''<br> • [[Hypopituitarism]]<br>• Chronic systemic diseases<br>• [[Anorexia nervosa]]<br>• Malnutrition<br>• [[Kallman syndrome]]<br>• [[Iatrogenic]]}} | |||
{{familytree | | |!| | | | | | |!| | | | | | |!| }} | |||
{{familytree |boxstyle=text-align: left; | | D01 | | | | | D02 | | | | | D03 |D01= '''''Actions: '''''<br>• Evaluation [[hypothalamus]]-[[pituitary]]-[[gonadal]] axis<br>• Consider an [[MRI]] to exclude the [[CNS]] lesions|D02= '''''Actions: '''''<br>• [[Chromosome]] analysis ([[Karyotyping]])|D03='''''Actions: '''''<br>• Upon the underlying disease }} | |||
{{familytree | | |!| | | | | | |!| | | | | | | | }} | |||
{{familytree |boxstyle=text-align: left; | | D01 | | | | | D02 | | | | | | | |D01= '''''Treatment: '''''<br>1. [[Psychologic]] support<br>2. Observation<br>3. [[Sex hormone]] replacement therapy|D02= '''''Treatment: '''''<br>1. [[Psychologic]] support<br>2. [[Sex hormone]] replacement<br>3. Excision of [[ovaries]] in [[Turner syndrome]] because of risk of [[malignancy]]}} | |||
{{familytree/end}} | |||
If a child is healthy but simply late, reassurance and prediction based on the bone age can be provided. No other intervention is usually necessary. In more extreme cases of delay, or cases where the delay is more extremely distressing to the child, a low dose of testosterone or estrogen for a few months may bring the first reassuring changes of normal puberty. | If a child is healthy but simply late, reassurance and prediction based on the bone age can be provided. No other intervention is usually necessary. In more extreme cases of delay, or cases where the delay is more extremely distressing to the child, a low dose of testosterone or estrogen for a few months may bring the first reassuring changes of normal puberty. | ||
Revision as of 19:38, 11 September 2017
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Delayed puberty Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Overview
Medical Therapy
| Delayed Puberty | |||||||||||||||||||||||||||||||||||
| Initial assessment | |||||||||||||||||||||||||||||||||||
| • Clinical history • Physical examinations • Pubertal phenotype • Left wrist radiograph for bone age | |||||||||||||||||||||||||||||||||||
| Unremarkable | Abnormal | Chronic disease | |||||||||||||||||||||||||||||||||
| • Delayed puberty • Lack of growth spurt • Bone age delayed upon chronological age | • Possibility of chromosomal disorder • Bone age may delayed | • Chronic disease • Decreased growth rate or short stature • Bone age delayed upon chronological age | |||||||||||||||||||||||||||||||||
| Diagnosis: • Constitutional delay of growth and puberty (CDGP) • Gonadotropin deficiency • Primary gonadal failure • Extreme athletic exercise | Diagnosis: Girls: • Turner syndrome Boys: • Klinefelter syndrome | Diagnosis: • Hypopituitarism • Chronic systemic diseases • Anorexia nervosa • Malnutrition • Kallman syndrome • Iatrogenic | |||||||||||||||||||||||||||||||||
| Actions: • Evaluation hypothalamus-pituitary-gonadal axis • Consider an MRI to exclude the CNS lesions | Actions: • Chromosome analysis (Karyotyping) | Actions: • Upon the underlying disease | |||||||||||||||||||||||||||||||||
| Treatment: 1. Psychologic support 2. Observation 3. Sex hormone replacement therapy | Treatment: 1. Psychologic support 2. Sex hormone replacement 3. Excision of ovaries in Turner syndrome because of risk of malignancy | ||||||||||||||||||||||||||||||||||
If a child is healthy but simply late, reassurance and prediction based on the bone age can be provided. No other intervention is usually necessary. In more extreme cases of delay, or cases where the delay is more extremely distressing to the child, a low dose of testosterone or estrogen for a few months may bring the first reassuring changes of normal puberty.
If the delay is due to systemic disease or undernutrition, the therapeutic intervention is likely to focus mainly on those conditions.
If it becomes clear that there is a permanent defect of the reproductive system, treatment usually involves replacement of the appropriate hormones (testosterone for boys, estradiol and progesterone for girls).