The presence of neurological symptoms in addition to lactation are signs of high prolactin levels and could indicate either a drug side effect or a prolactinoma. Imaging
Since bone maturation is a good indicator of overall physical maturation, an x-ray of the left hand and wrist to assess bone age usually reveals whether the child has reached a stage of physical maturation at which puberty should be occurring. X-ray displaying a bone age <11 years in girls or <13 years in boys (despite a higher chronological age) is most often consistent with constitutional delay of puberty. An MRI of the brain should be considered if neurological symptoms are present in addition to delayed puberty, two findings suspicious for pituitary or hypothalamic tumors. An MRI can also confirm the diagnosis of Kallmann syndrome due to the absence or abnormal development of the olfactory tract. However, in the absence of clear neurological symptoms, an MRI may not be the most cost-effective option. A pelvic ultrasound can detect anatomical abnormalities including undescended testes and müllerian agenesis. Laboratory evaluation
The first step in evaluating children with delayed puberty involves differentiating between the different causes of delayed puberty. Constitutional delay can be evaluated with a thorough history, physical, and bone age. Malnutrition and chronic diseases can be diagnosed through history and disease-specific testing. Screening studies include a complete blood count, an erythrocyte sedimentation rate, and thyroid studies.
Children with delayed puberty also display decreased academic performance in their adolescent education, but changes in academic achievement in adulthood have not been determined.There is conflicting evidence as to whether or not children with constitutional growth and pubertal delay reach their full height potential. The conventional teaching is that these children catch up on their growth during the pubertal growth spurt and just remain shorter before their delayed puberty starts. However, some studies show that these children fall short of their target height from about 4 to 11 cm. Factors that could affect final height include familial short stature and pre-pubertal growth development.Pubertal delay can also affect bone mass and subsequent development of osteoporosis. Men with delayed puberty often have low to normal bone mineral density unaffected by androgen therapy. Women are more likely to have lower bone mineral density and thus an increased risk of fractures as early as even before the onset of puberty.Furthermore, delayed puberty is correlated with a higher risk in cardiovascular and metabolic disorders in women only, but also appears to be protective for breast and endometrial in women and testicular cancer in men. See also
Developmental milestones
Endocrinology
Puberty
Constitutional growth delay
Hypogonadism
Kallmann syndrome
Turner syndrome
Klinefelter syndrome

References


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