Delayed puberty natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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 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 occur normal in the future, without any hormone replacement.
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 25 cm of height in girls and 30 cm in boys.
- Delayed puberty can identified in boys, if:[1]
- No sign of testicular enlargement by 14 years of the age
- No pubic hair by 15 years of age
- No penis and testicles development to adult type 5 years after puberty beginning
- Delayed puberty can identified in girls, if:[1]
- No signs of breast development by 14 years of age
- No pubic hair by 14 years of age
- No breast development to adult type 5 years after puberty beginning
- No menstruation periods by 16 years of age
Complications
Osteoporosis
- Lack of estrogen and other sex steroids can cause decreasing the bone mineralization and osteoporosis.[2]
- The amount of bone mass that ever person has gained during the puberty is the key factor not to involve in osteoporosis.[2]
- 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.[3]
Psychological problems
- 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, lead to increasing hematocrit.
Irritation from gels and patches
- Therapeutic hormonal gels and patches that are frequently used in delayed puberty can cause allergenic reactions, irritation is prevalent.
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.
- 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.
References
- ↑ 1.0 1.1 "Complications of puberty - Ireland's Health Service".
- ↑ 2.0 2.1 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.