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Clinical “Red Flags” Differentiating Delayed Puberty From Enduring Hypogonadism

Published:October 22, 2022DOI:https://doi.org/10.1016/j.nurpra.2022.09.019

      Highlights

      • Delayed pubertal onset is a common reason for endocrine consultation.
      • No gold standard test exists to differentiate self-limited constitutional delay of puberty and abiding hypogonadism (congenital hypogonadotropic hypogonadism).
      • Constitutional delay of puberty and congenital hypogonadotropic hypogonadism can have significant psychosocial sequelae.
      • Identifying red flags of congenital hypogonadotropic hypogonadism can accelerate diagnosis and timely initiation of treatment to improve health and well-being outcomes.

      Abstract

      Delayed puberty affects between 2% and 3% of the population and is a common reason for seeking endocrine consultation. Evaluation involves ruling out pathologic functional conditions disrupting puberty. Adolescents with constitutional delay of puberty (CDP) will initiate puberty spontaneously, albeit later than peers. However, some individuals have congenital hypogonadotropic hypogonadism (CHH) and will neither initiate nor progress in pubertal development. No single gold standard test differentiates CDP from CHH, posing diagnostic challenges for clinicians. This report provides an overview of normal/disrupted puberty, highlights clinical “red flags” facilitating identification of CHH, and emphasizes comprehensive and interprofessional approaches to care.

      Keywords

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      Biography

      Both authors are at Massachusetts General Hospital, Harvard Center for Reproductive Medicine, Boston. Andrew A. Dwyer, PhD, FNP-BC, is also an associate professor at the William F. Connell School of Nursing, Boston, College, Chestnut Hill, MA, and can be contacted at [email protected] .

      Biography

      Yee-ming Chan, MD, PhD, is also with the Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA.