When to be wary
Puberty begins at a wide range of ages, and a late onset often follows a family pattern: the teenager's father or mother had the same experience. Doctors focus on specific boundaries. In girls, it is alarming if by the age of 13 there is no enlargement of the mammary glands or by the age of 15 there is no menstruation, and also if more than five years have passed since the start of development without menarche. In boys - if by the age of 14 the testicles have not enlarged or the process began but stopped. An additional benchmark is stunting and low annual growth rate.
- Girls: no breast growth by age 13
- Girls: no periods by age 15
- Boys: no testicular enlargement by age 14
- Stopping the development that has begun
- Growth rate is less than normal for age
- Lag behind the growth curve in the medical record
Reasons
The most common option is constitutional retardation of growth and puberty, a variant of the norm with a family predisposition. The second group is functional reasons, when the body delays maturation due to lack of resources: chronic diseases of the intestines, kidneys, heart, celiac disease, severe weight loss, eating disorders, high-impact sports, untreated hypothyroidism. The third is diseases of the regulatory system itself: pituitary failure, tumors, effects of radiation, congenital syndromes, as well as primary failure of the gonads, including those with chromosomal features.
- Constitutional delay with family predisposition
- Chronic diseases and malabsorption
- Weight loss and eating disorders
- Intense sports activities
- Hypothyroidism and other endocrine diseases
- Tumors and pituitary failure
- Primary testicular or ovarian failure
- Chromosomal syndromes
How does a teenager experience it?
The medical side of the issue often fades into the background compared to the psychological. A teenager is shorter than his classmates, looks younger, is teased, avoids locker rooms and sports activities, withdraws, and studies worse. It is important for parents not to devalue these experiences with phrases that everything will come on its own. An explanation of what is happening to the body, a clear examination plan and a time frame for a follow-up visit relieve a significant part of the anxiety. If your mood is persistently depressed, there are thoughts about your own uselessness or self-harm, you need the help of a psychologist or psychiatrist without delay.
- Feeling different from peers
- Avoiding sports and locker rooms
- Decreased self-esteem and academic performance
- Anxiety in parents and pressure on the child
- The benefits of a clear examination plan
- If your mood is persistently low, seek help from a specialist
Survey
The doctor assesses height, weight, body proportions, stage of sexual development, sense of smell and examines the external genitalia. An x-ray of the hand is required to determine bone age: with a constitutional delay, it lags behind the passport age, which precisely provides a reserve for growth. Next, LH, FSH, testosterone in boys and estradiol in girls are determined, TSH, prolactin and general tests are added to exclude chronic diseases. The combination of low LH and FSH indicates a problem in the pituitary gland, high levels indicate insufficiency of the gonads. According to indications, a karyotype, MRI of the pituitary gland and ultrasound of the pelvis are prescribed.
- Assessment of height, weight and stage of development
- X-ray of the hand for bone age
- LH, FSH, testosterone or estradiol
- TSH, prolactin, complete blood count
- Screening for celiac disease and assessing kidney function as indicated
- Karyotype if a chromosomal cause is suspected
- MRI of the pituitary gland and ultrasound of the pelvis according to indications
Treatment and prognosis
With constitutional delay, treatment is often not required: an explanation, observation and re-examination after six months are sufficient. If a teenager is experiencing severe retardation, a short course of sex hormones in a low dose is possible, which triggers development and accelerates growth without reducing final height; This treatment is prescribed only by a pediatric endocrinologist. For functional reasons, the main thing is to restore nutrition, cure the underlying disease, and review the load. In case of insufficiency of the pituitary gland or gonads, long-term replacement therapy is carried out, and issues of future fertility are discussed separately.
- Follow-up and re-evaluation after 6 months
- A short course of hormones as prescribed by an endocrinologist
- Normalization of nutrition and body weight
- Reducing excessive sports activity
- Treatment of hypothyroidism and chronic diseases
- Long-term replacement therapy for insufficiency
- Psychological support for teenagers and families
