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Delayed puberty
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=== Laboratory evaluation === [[File:Delayed Puberty.png|alt=|thumb|Workup for delayed puberty]] The first step in evaluating children with delayed puberty involves differentiating between the different causes of delayed puberty. Constitutional delay can be evaluated with a thorough history, physical, and bone age.<ref name=":11" /> Malnutrition and chronic diseases can be diagnosed through history and disease-specific testing.<ref name=":1" /> Screening studies include a complete blood count, an [[erythrocyte sedimentation rate]], and thyroid studies.<ref name=":1" /> [[Hypogonadism]] can be differentiated between hyper- and hypo-gonadotropic hypogonadism by measuring serum [[follicle-stimulating hormone]] (FSH) and [[luteinizing hormone]] (LH) ([[gonadotropin]]s to measure pituitary output), and estradiol in girls (to measure gonadal output).<ref name=":0" /><ref name=":5" /> By the age of 10β12, children with failure of the ovaries or testes will have high LH and FSH because the brain is attempting to jump-start puberty, but the gonads are not responsive to these signals.<ref name=":0" /><ref name=":1" /> Stimulating the body by administering an artificial version of [[gonadotropin-releasing hormone]] (GnRH, the hypothalamic hormone) can differentiate between constitutional delay of puberty and a GnRH deficiency in boys, although no studies have been done in girls to prove this.<ref name=":0" /><ref>{{cite journal | vauthors = Jungmann E, Trautermann C | title = [The status of the gonadotropin releasing hormone test in differential diagnosis of delayed puberty in adolescents over 14 years of age] | language = de | journal = Medizinische Klinik | volume = 89 | issue = 10 | pages = 529β33 | date = October 1994 | pmid = 7808353 }}</ref> It is often sufficient to simply measure the baseline gonadotrophin levels to differentiate between the two.<ref name=":7" /> In girls with [[hypogonadotropic hypogonadism]], a serum [[prolactin]] level is measured to identify if they have the pituitary tumor [[prolactinoma]]. High levels of prolactin would warrant further testing with MRI imaging, except if drugs inducing the production of prolactin can be identified.<ref name=":0" /> If the child has any neurological symptoms, it is highly recommended that the physician obtains a head MRI to detect possible brain lesions.<ref name=":0" /> In girls with [[hypergonadotropic hypogonadism]], a [[karyotype]] can identify chromosomal abnormalities, the most common of which is [[Turner syndrome]].<ref name=":0" /> In boys, a karyotype is indicated if the child may have a congenital gonadal defect such as [[Klinefelter syndrome]].<ref name=":1" /> In children with a normal karyotype, defects in the synthesis of the [[Adrenal gland|adrenal]] steroid sex hormones can be identified by measuring [[17-hydroxylase]], an important enzyme involved in the production of sex hormones.<ref name=":0" />
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