Delayed Puberty (2)

Question 1

What is it defined as?

What is the most common cause of it?
→ What occurs in these children?

Answer 1

➊ No pubertal development by 13 yrs in girls and 14 yrs in boys

➋ Constitutional delay of growth and puberty
→ They enter normal puberty later than their peers = “Late bloomers”

Question 2

Hypogonadotrophic Hypogonadism:
What is this?

What are its causes?

Answer 2

➊ Deficiency of LH and FSH → Low Testosterone and Oestrogen

➋ • Damage to Hypothalamus or Pituitary (e.g. surgery, cancer)
• GH deficiency
• Hypothyroidism
• Hyperprolactinaemia
• Excessive exercise or dieting
• Kallman syndrome

Question 3

Hypergonadotrophic Hypogonadism:
What is this?

What are its causes?

Answer 3

➊ • Gonads fail to respond to stimulation from LH and FSH
• High LH and FSH → Low Testosterone and Oestrogen

➋ • Previous damage to Gonads (e.g. torsion, cancer, infection)
• Congenital absence of gonads
• Turner’s syndrome
• Kleinfelter’s syndrome

Question 4

What is the important investigation to do here?
→ Why is this done?

What other investigations may be done?

Answer 4

➊ Wrist XR
→ Check for constitutional delay

➋ • Bloods – FBC, U&E, LH, FSH, TFTs, IGF-1, Prolactin, Anti-TTG
• Genetic testing – Turner’s, Kleinfelter’s
• Imaging – Pelvic US in girls, MRI Brain (check for pituitary/hypothalamus pathology)