DELAYED PUBERTY

Because most of the causes of delayed puberty are hormonal in origin, the key to recalling them will be visualizing the anatomy, particularly the endocrine glands.

DELAYED PUBERTY

1. Hypothalamus and pituitary: Lack of gonadotropin-releasing hormone from hypothalamic disorders such as Lawrence–Moon–Biedl syndrome, space-occupying lesions, trauma, or infection may cause delayed puberty in girls and boys. Chromophobe adenomas, prolactinomas, craniopharyngiomas, trauma, granulomas, and vascular lesions may decrease the production of growth hormone and other pituitary hormones causing delayed puberty.
2. Thyroid: Both hypothyroidism and hyperthyroidism in children may cause delayed puberty.
3. Adrenal gland: Visualizing this organ will prompt the recall of congenital adrenocortical hyperplasia and Cushing syndrome.
4. Ovaries: Ovarian dysgenesis (Turner syndrome, etc.), autoimmune oophoritis, and Noonan syndrome are associated with delayed puberty in girls. A masculinizing tumor of the ovary will present with delayed puberty on occasion.
5. Testicles: Irradiation, Klinefelter syndrome, Noonan syndrome, castration, and anorchism may cause delayed puberty in boys. Mumps rarely is the cause.

The above method of recall will omit the chronic illnesses such as anorexia nervosa, malnutrition, renal failure, tuberculosis, celiac disease, collagen disease, and cyanotic heart disease that may cause delayed puberty. It also will not prompt the recall of drugs that cause delayed puberty such as thyroid hormone, anabolic steroids, and androgens in girls and thyroid hormones in boys.

It important to remember that over half the cases of delayed puberty in boys and 16% of cases in girls are due to constitutional delayed puberty.

Approach to the Diagnosis

The physician is frequently consulted early about this problem by an overprotective parent so it important to remember that there is little cause for alarm until age 15 in boys and age 14 in girls. Nevertheless, a workup may be started early if other telltale signs of pathology such as short stature, web neck, or small or absent testicles are found. The workup will probably include a thyroid profile, serum testosterone (boys), estradiol (girls), and FSH and LH assay. Urine gonadotropins are less expensive screening tests. Pelvic ultrasound and CT scans of the abdomen and pelvis will help identify ovarian and adrenal causes. A CT scan or MRI of the brain will identify most pituitary causes.

Other Useful Tests

1. Testicular biopsy (Klinefelter syndrome)
2. Buccal smear for Barr bodies (Klinefelter syndrome)
3. CBC and chemistry panel (renal failure)
4. Gynecology consult
5. Psychiatric consult
6. Visual field examination (pituitary tumor)
7. Serum growth hormone assay (pituitary tumor)
8. Urine drug screen (drug abuse)
9. Serum free cortisol (Cushing syndrome)
10. Full karyotyping (Klinefelter syndrome, Turner syndrome)
11. Laparoscopy (ovarian dysgenesis)
12. Serum prolactin (pituitary tumor)
13. Endocrine consult

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Delayed puberty

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

More About Causes of Delayed puberty

• Back to symptom: Delayed puberty: Introduction (review 251 causes)
• Next Book Extract About Delayed puberty: DELAYED PUBERTY (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Delayed puberty

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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