Diagnosis Delayed puberty

1 diagnosis

1.1 evaluation

1.1.1 lateness
1.1.2 discordance
1.1.3 indications of specific disorders

diagnosis

pediatric endocrinologists physicians training , experience evaluating delayed puberty. complete medical history, review of systems, growth pattern, , physical examination reveal of systemic diseases , conditions capable of arresting development or delaying puberty, providing clues of recognizable syndromes affecting reproductive system.

since bone maturation indicator of overall physical maturation, x-ray of hand assess bone age reveals whether child has reached stage of physical maturation @ puberty should occurring. visible secondary sexual development begins when girls achieve bone age of 11 years, , boys achieve bone age of 12 years.

the valuable blood tests gonadotropins, because elevation confirms defect of gonads or deficiency of sex steroids. in many instances, screening tests such complete blood count, general chemistry screens, thyroid tests, , urinalysis may worthwhile.

more expensive , complicated tests, such karyotype or magnetic resonance imaging of head, obtained when specific evidence suggests may useful.

use of gonadotropin releasing hormone can of value in differential diagnosis.

if delayed puberty accompanied lack of sense of smell (anosmia) or history of un-descended testicles (cryptorchidism) when born diagnosis of kallmann syndrome considered.

evaluation

there 3 indications pubertal delay may due abnormal cause.

lateness

the first degree of lateness: although no recommended age of evaluation cleanly separates pathologic physiologic delay, delay of 2–3 years or more warrants evaluation.

in girls, no breast development 13 years, or no menarche 3 years after breast development (or 16).
in boys, no testicular enlargement 14 years, or delay in development 5 years or more after onset of genitalia enlargement.

a delay of 2 standard deviations has been proposed standard.

discordance

the second indicator discordance of development. in children, puberty proceeds predictable series of changes in specific order. in children ordinary constitutional delay of growth , puberty, aspects of physical maturation typically remain concordant few years later average. if aspects of physical development delayed, , others not, wrong.

for instance, in girls, beginning stages of breast development precede pubic hair. if 12-year-old girl reach tanner stage 3 pubic hair year or more without breast development, unusual enough suggest abnormality such defective ovaries.
similarly, if 13-year-old boy had reached stage 3 or 4 pubic hair testes still remained prepubertal in size, unusual , suggestive of testicular abnormality.

indications of specific disorders

the third indicator presence of clues specific disorders of reproductive system.

malnutrition or anorexia nervosa severe enough delay puberty give other clues well.
poor growth suggest possibility of coeliac disease, hypopituitarism or turner syndrome.
reduced sense of smell (hyposmia) or no sense of smell (anosmia) suggests kallmann syndrome.




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