Delayed onset of puberty- what to do?
An 18-year-old man was referred for evaluation of delayed puberty. History revealed that he had never grown facial, axillary or pubic hair, his voice had not changed, and he rarely had acne or body odour. His mother recalled that he was quite small as a young child but, after five years of age, seemed to grow normally. She also reported that his energy level was quite low and he rarely left the house except for school. He missed approximately five days of school each month because of illness.
@minti The most common cause of delayed puberty is a functional delay in production of gonadotropin-releasing hormone (GnRH) from the hypothalamic neuronal networks that synergize to initiate the episodic or pulsatile release of the GnRH. GnRH then stimulates pituitary production of the gonadotropins: luteinizing hormone (LH), which stimulates steroidogenesis in the gonads, and follicle-stimulating hormone (FSH), which stimulates gametogenesis. This delay may be due to individual genetic variations, known as constitutional delay of growth and puberty (CDGP), or other functional defects, such as undernutrition or chronic illness. The resulting GnRH deficiency leads to delays in the secretion of LH and FSH and the subsequent gonadal secretion of sex steroids and in gametogenesis. Other causes of delayed puberty include a variety of hypothalamic, pituitary, and gonadal disorders.