Some of the major causes of delayed puberty are constitutional delay
in growth and development, hypergonadotropic hypogonadism and hypogonadotropic hypogonadism (HH) (Geffner, 2002).
1 Causes of short stature can either be normal variants of growth like familial short stature and constitutional delay
of growth and puberty(CDGP)2,3 or it can be a result of chronic systemic diseases (renal, pulmonary and cardiac diseases, coeliac disease)4,5 endocrine disorders (hypopituitarism, isolated growth hormone deficiency, isolated hypothyroidism, endogenous and exogenous Cushing syndrome, adrenal insufficiency, osteomalacia or rickets),6-9 genetic (cystic fibrosis),10 chromosomal disorders (Turners syndrome)11 and skeletal dysplasias.
Background: Delayed puberty can result either from constitutional delay
of growth and puberty (CDP) or idiopathic hypogonadotropic hypogonadism (IHH).
Diagnosis Secondary sexual Characters 1 Utero-vaginal agenesis Normal 2 Androgen insensitivity Normal 3 Outflow obstruction Normal 4 Constitutional delay
, Normal PCOS, Prolactinoma Sr.
This delayed bone age suggests that the child with constitutional delay
will also reach his or her gender-determined, mid-parental height.
Possible causes include hypothalamic or pituitary lesions, such as tumors or caseating lesions, hypophysitis, hyperprolactinemia, thyroid disease, or constitutional delay
An MRI of the hypothalamic-pituitary area should be obtained.
Skeletal maturity assessment plays a pivotal role in confirming the diagnosis of normal variants of growth such as familial short stature and constitutional delay
of growth, in interpreting hormone tests during puberty and in the diagnosis of precocious puberty or delayed puberty.
11 Constitutional delay
of growth and maturation (CDGM) having subtle defects in growth hormone-insulin like growth factor (GH-IGF) axis, obligates higher rates of overall energy expenditure compared with age and size matched controls, this increased metabolism may result in impaired tempo of growth.
The by-elections were scheduled in 42 electoral constituencies for the provincial and national assemblies in the country after polling was called off in those seats because of the law and order situation and procedural or constitutional delays