Delayed puberty natural history, complications and prognosis: Difference between revisions

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Latest revision as of 21:15, 29 July 2020

Delayed puberty Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Delayed puberty from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

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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 ages 8 to 13 in girls and 9 to 14 in boys and start with breast development in girls and testicular enlargement in boys. If the testicular enlargement or breast development has not occurred at a mean age of puberty in population plus 2-2.5 standard deviation (SD), it will be called delayed puberty. The mean age depends on various factors, such as race, nutrition, and also socioeconomic status. Recently, the age of onset of puberty is decreasing in the 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 ages 8 to 13 in girls and ages 9 to 14 in boys and start with breast development in girls and testicular enlargement in boys.
  • If the testicular enlargement or breast development has not occurred at a mean age of puberty in population plus 2-2.5 SD, it will be called delayed puberty. The mean age depends on various factors, such as race, nutrition, and also socioeconomic status. Recently, the age of onset of puberty is decreasing in the US and other countries.
  • If left untreated, all of the patients with a 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

OR

Delayed puberty in girls is identified as:[1]

  • No signs of breast development by 14 years of age

OR

OR

  • No breast development to adult type 5 years after onset of puberty

OR

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

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

Psychological problems[5]

Polycythemia

Irritation from gels and patches

  • Therapeutic hormonal gels and patches that are frequently used in delayed puberty can cause allergic reactions and irritation.

Prognosis

References

  1. 1.0 1.1 "Complications of puberty - Ireland's Health Service".
  2. 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.
  3. 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.
  4. Lee PD, Rosenfeld RG (1987). "Psychosocial correlates of short stature and delayed puberty". Pediatr. Clin. North Am. 34 (4): 851–63. PMID 3302895.
  5. "Delayed puberty Prognosis - Epocrates Online".

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