Overall, neither growth hormone nor aromatase inhibitors are recommended for constitutional delay to increase growth.Girls can be started on estrogen with the same goals as their male counterparts.Overall, studies have shown no significant difference in final adult height between adolescents treated with sex steroids and those who were only observed with no treatment. Malnutrition or chronic disease
If the delay is due to systemic disease or malnutrition, the therapeutic intervention is likely to focus direction on those conditions. In patients with coeliac disease, an early diagnosis and the establishment of a gluten-free diet prevents long-term complications and allows restoration of normal maturation. Thyroid hormone therapy will be necessary in the case of hypothyroidism. Primary failure of the ovaries or testes (hypergonadotropic hypogonadism)
Whereas children with constitutional delay will have normal levels of sex hormones post-puberty, gonadotropin deficiency or hypogonadism may require lifelong sex steroid replacement.In girls with primary ovarian failure, estrogen should be started when puberty is supposed to start. Progestins are usually added after there is acceptable breast development, about 12 to 24 months after starting estrogen, as starting treatment with progestin too early can negatively affect breast growth. After acceptable breast growth, administering estrogen and progestin in a cyclical manner can help establish regular menses once puberty is started. The goal is to complete sexual maturation over 2 to 3 years. Once sexual maturation has been achieved, a trial period with no hormonal therapy can determine whether or not the child will require life-long treatment.
Clot evacuation can be performed by placing a wide-lumen bladder catheter at bedside. The bladder can be irrigated with water or sodium chloride solution. The use of water is preferable because water can help with clot lysis. Care must be taken to not overdistend the bladder and cause a perforation. Hyperbaric oxygen (HBO2) therapy has been proven to be effective in treating radiation-induced hemorrhagic cystitis. == References ==