Malnutrition or chronic disease
When underweight or sickly children present with pubertal delay, it is warranted to search for illnesses that cause a temporary and reversible delay in puberty. Chronic conditions such as sickle cell disease and thalassemia, cystic fibrosis, HIV/AIDS, hypothyroidism, chronic kidney disease, and chronic gastroenteric disorders (such as coeliac disease and inflammatory bowel disease) cause a delayed activation of the hypothalamic region of the brain to send signals to start puberty.Childhood cancer survivors can also present with delayed puberty secondary to their cancer treatments, especially males. The type of treatment, amount of exposure/dosage of drugs, and age during treatment determine the level by which the gonads are affected with younger patients at a lower risk of negative reproductive effects.Excessive physical exercise and physical stress, especially in athletes can also delay pubertal onset. Eating disorders such as bulimia nervosa and anorexia nervosa can also impair puberty due to undernutrition.Carbohydrate-restricted diets for weight loss has also been shown to decrease the stimulation of insulin which in turn does not stimulate kisspeptin neurons vital in the release of puberty-starting hormones. This shows that carbohydrate restricted children and children with diabetes mellitus type 1 can have delayed puberty. Primary failure of the ovaries or testes (hypergonadotropic hypogonadism)
Primary failure of the ovaries or testes (gonads) will cause delayed puberty due to the lack of hormonal response by the final receptors of the HPG axis.
The jury, after deliberating for 15 days, issued guilty verdicts against the companys founder, the one-time billionaire John Kapoor, and four former executives, finding they had conspired to fuel sales of its highly potent drug, Subsys, by not only bribing doctors to prescribe its product but also by misleading insurers about patients need for the drug. Other Insys employees also found guilty included Richard M. Simon, former national director of sales; Sunrise Lee, regional sales director; Joseph A. Rowan, regional sales director; and Michael J. Gurry, former vice president of managed markets. A sentencing hearing has not been scheduled but is expected to take place in early August 2019. In June 2019, Insys Therapeutics agreed to pay $225 million to settle the federal governments criminal and civil investigations into the companys marketing practices. In January 2020, Kapoor was sentenced by a federal court to five and a half years in prison.Insys filed for bankruptcy in Delaware Bankruptcy Court on June 10, 2019. Andrew Long, the companys CEO, claims the company is struggling due to: 1) extensive litigation, and 2) declining revenues relating to its Subsys product. The bankruptcy filing came just 10 days after the company reached a settlement with the U.S. Justice Department. The U.S. government has agreed to accept an unsecured claim of $190 million in the case. See also
The Crime of the Century

References


== External links ==