Delayed Puberty in Children – Pediatrics | Lecturio

Delayed Puberty in Children – Pediatrics | Lecturio

Delayed Puberty in Children – Pediatrics | Lecturio

By Bryan Wright 2 Comments September 11, 2019


[Music] so causes of delayed puberty and boys are multiple but generally the if they’re central they are more likely to be a cancer in boys we’re gonna suspect these if there’s no testicular enlargement after 14 years of age in girls we’re gonna suspect delayed puberty if there’s no thigh larkey by the age of 13 so boys are allowed an extra year delay they start later they finish later keep in mind though that two and a half percent of healthy boys and girls do have delayed puberty we’re using this cut-off so that we can check kids as early as we can without having to test too many children so what are the types of delayed puberty well we have constitutional lay this is by far the most common these are simply children who are having their puberty later much like they might have a later growth spurt this is common if there’s a family history of delay if the parents don’t have a delay in their pubertal development or also in children who have excessive exercise or work very hard at a sport sometimes this will happen there may be a problem with the ganado trophy the ganado troph ins are FSH and LH this would be hypo ganado trophic hypogonadism in other words their gonads are less productive because of a hypo ganado trophic state this is a problem with the brain or they might have primary go nan-oh failure which is hyper go now to trophic hypogonadism this is because they have lots of ganado troughs and very little response so let’s drill down on causes of hypogonadism when the when the ganado troph ins are the problem there are some central issues that we might see one classic example is calman syndrome this is an isolated deficiency in the pituitary and also these patients often have a nas mia so they’re not smelling very well because of a problem with the first grail nerve they will have isolated deficiency of production of their gonadotrophins this can be functional as well patients with eating disorder excessive exercise some of our real star athletes will have a delay in their puberty and that’s a central process like we stated in boys often it’s a pituitary lesion so we need to worry about the tuatara lesions in these children and certainly we would worry about it in a child who has a history of pituitary surgery remember resection of the two eteri adenoma z’ carries with it about a 15% chance of being having problems with pituitary endocrine function afterwards flipside if there’s primary go nate’ll failure we have to think about some other potential causes of what’s going on there are some genetic causes such as Klinefelter’s which is X X Y or Turner syndrome which is just one X and in both those genetics situations children have a decreased responsiveness of their gonads to the ganado trophy that’s trying to get them stimulated also patients may have a history of irradiation of the testes or chemotherapy or rarely children can have autoimmune ovary disease which will result in a hypokinetic gun gonads state where there’s hyper ganado trophic levels of hormone FSH and LH which are trying to stimulate a diseased ovary so if we have delayed puberty in a healthy child we’re going to check LH FSH estradiol and girls and as testosterone boys if the child has a concern it’s going to be largely guided by our exam what is the problem consider thyroid hormone levels prolactin levels and CBC and sed rate as a way of measuring chronic malingering condition delayed puberty if there’s constitutional delay we’re gonna manage them simply by reassurance eventually your child’s going to have their period don’t you worry about a thing for boys we typically treat this with tests all drone injections typically these happen about once a month it’s not too troublesome families don’t usually have a problem with it but it is expensive and so you probably will have to document testosterone deficiency prior to the insurance company being willing to pay for the therapy for girls with delay you can consider initiation of estrogen therapy usually we simply put them on an estrogen pill like an oral contraceptive pill and that will start to promote the puberty and get them regular so that’s all I have today about delayed puberty and how we deal with that problem thanks for your attention [Music]

2 Comments found

User

srinivasa rao sirasapalli

so nicely explained

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User

Luzidツ

Now u got me scared wth

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