Puberty tarda

Classification according to ICD-10
E30.0	Delayed puberty [pubertas tarda]
ICD-10 online (WHO version 2019)

Under delayed puberty (from Latin puberty "maturity" and tardus "inhibited") refers to the delayed, incomplete or complete lack of development of puberty in girls and boys.

definition

"Puberty tarda is when the otherwise healthy girl (boy) beyond a chronological age of 13.5 (14) years does not show any signs of puberty, if the time required to go through puberty from stage B2 to menarche (from the first signs of reaching a Tanner stage P5 G5) is more than 5.0 (5.5) years or if the development of puberty has stopped for more than 18 months. "

Differential diagnosis of puberty tarda

Several causes are known for delayed or absent puberty:

Constitutional Development Delay: Most common cause of delayed puberty. Family-related, late development of puberty, but subsequently normal development. As a rule, therefore, this can already be proven in the parents, so the puberty history of the parents should be recorded (casually also "late bloomer" or "late developer", in technical terms earlier also pseudoeunuchoidism )
(Real) hypogonadism :
- Hypergonadotropic hypogonadism :
1. Primary: ( Hormonal ) insufficiency of the gonads . In girls, for example, in the context of Ullrich-Turner syndrome , in boys in the context of Klinefelter syndrome , in the case of anorchia or androgen resistance
2. Secondary: After radiation , chemotherapy , especially for tumors of the small pelvis, for ALL , but also for chronic consuming or inflammatory diseases such as Crohn's disease .
- Hypogonadotropic hypogonadism : Insufficient gonadotropin secretion from the pituitary gland , usually combined with further failures of pituitary hormones . Here, too, either primarily or secondarily, for example due to tumors or the consequences of their therapy, post-traumatic or post-inflammatory.

clinic

The development of the organism at puberty tarda is clearly delayed, in the worst case puberty does not occur at all. The development of secondary sexual characteristics (thelarche, pubarche, menarche) occurs too late. Associated with this, there is also delayed skeletal maturity . Due to the lack of a growth spurt in puberty , body size deviates from the previous course of the percentile curve. In rarer cases, depending on the cause, the epiphyseal plates may be delayed in closing with consecutive tall growth .

Occasionally, psychological problems arise due to the delayed development of puberty.

Diagnosis

The clinical documentation of puberty tarda is based on the puberty stage according to Tanner . The estrogens or androgens , prolactin and gonadotropins ( FSH , LH ) in the blood are determined in a laboratory . In addition to laboratory diagnostics, the determination of skeletal maturity or bone age (for example using the methods of Greulich and Pyle or Tanner and Whitehouse) is one of the necessary diagnostic measures. The puberty development of the internal female genitalia is documented sonographically .

therapy

Tumors require surgical or radiotherapy or chemotherapy treatment. Substitution of the missing hormones and thus initiation of puberty (which, however, does not lead to success in boys with androgen receptor resistance ).

Individual evidence

^ German Society for Pediatrics and Adolescent Medicine (DGKJ): Guideline of the German Society for Pediatrics and Adolescent Medicine (DGKJ) - Pubertas tarda and hypogonadism. (No longer available online.) In: awmf.org. Working Group of the Scientific Medical Associations eV, 2011, archived from the original on September 23, 2015 ; accessed on March 1, 2014 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2
↑ Gerald Hellstern, Martin Bald, Claudia Blattmann, Hans Martin Bosse (eds.): Short textbook pediatrics . Georg Thieme Verlag , 2012, ISBN 978-3-13-170311-8 , p. 42 ( limited preview in Google Book search).
↑ Hans Ewerbeck: Differential Diagnosis of Diseases in Childhood: A Guide for Clinic and Practice . Springer, 2013, ISBN 978-3-662-06714-7 , pp. 235 ( limited preview in Google Book Search).
↑ Ludwig Weissbecker: The gonadal insufficiency. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 1027-1032, here: s. 1028 f.

[1] German Society for Pediatrics and Adolescent Medicine (DGKJ): Guideline of the German Society for Pediatrics and Adolescent Medicine (DGKJ) - Pubertas tarda and hypogonadism. (No longer available online.) In: awmf.org. Working Group of the Scientific Medical Associations eV, 2011, archived from the original on September 23, 2015 ; accessed on March 1, 2014 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2

[2] Gerald Hellstern, Martin Bald, Claudia Blattmann, Hans Martin Bosse (eds.): Short textbook pediatrics . Georg Thieme Verlag , 2012, ISBN 978-3-13-170311-8 , p. 42 ( limited preview in Google Book search).

[3] Hans Ewerbeck: Differential Diagnosis of Diseases in Childhood: A Guide for Clinic and Practice . Springer, 2013, ISBN 978-3-662-06714-7 , pp. 235 ( limited preview in Google Book Search).

[4] Ludwig Weissbecker: The gonadal insufficiency. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 1027-1032, here: s. 1028 f.