ABSTRACT
Precocious puberty has been defined as the development of secondary sex characteristics before 8 years of age in girls. In the past, therapy with progestational agents, such as medroxyprogesterone acetate or cyproterone acetate had been used. The gonadotropine releasing hormone agonist has been used widely. The ethiologies of delayed sexual development are numerous. A series of 191 patients with delayed pubertal development is reported in this study. Gonadal dysgenesis is 39/119(32.8%), physiologic delay is 27/119(22.7%), Rokitansky syndrome is 17/119(14.3%), hyperprolactinemia is 11/119(9.2%). The girls with physiological delay, hyperprolactinemia or poly cystic ovary syndrome, have subsequent normal reproductive potential. In the treatment of abnormal pubertal development, the individual treatment is important.
Subject(s)
Puberty, Delayed/therapy , Puberty, Precocious/therapy , Child , Chorionic Gonadotropin/administration & dosage , Cyproterone Acetate/administration & dosage , Diagnosis, Differential , Estrogens, Conjugated (USP)/administration & dosage , Female , Gonadotropin-Releasing Hormone/administration & dosage , Gonadotropin-Releasing Hormone/analogs & derivatives , Humans , Medroxyprogesterone Acetate/administration & dosage , Puberty, Delayed/classification , Puberty, Delayed/diagnosis , Puberty, Delayed/etiology , Puberty, Precocious/classification , Puberty, Precocious/diagnosis , Puberty, Precocious/etiologyABSTRACT
Se revisa la fisiología de la maduración sexual, desde la vida intrauterina hasta la pubertad, con énfasis en los eventos que ocurren durante la pubertad tanto en la mujer como en el varón. Luego se describen las alteraciones que ocurren en el desarrollo de la pubertad: pubertad precoz y pubertad tardía , sus causas, metodología diagnóstica y posibilidades tarapéuticas. Y, en la tercera parte del artículo se comentan las variaciones normales de la pubertad: adrenarquia prematura, telarquia prematura, menarquia prematura y ginecomastia puberal.
Subject(s)
Humans , Male , Female , Puberty/physiology , Puberty, Precocious/classification , Puberty, Precocious/diagnosis , Puberty, Precocious/therapy , Gynecomastia/diagnosis , Gynecomastia/physiopathology , Gynecomastia/therapy , Sexual Maturation/physiology , Puberty, Delayed/classification , Puberty, Delayed/diagnosis , Puberty, Delayed/therapyABSTRACT
The effects of chronic renal failure on the pituitary-testicular axis of 31 males, aged 11.7 to 20.0 yr (mean, 16.0 yr) were studied. Nine patients not on hemodialysis (group I) had serum creatinines between 2.5 and 8.0 mg/dl, 10 patients were on hemodialysis (group II) and 12 patients had received a renal transplant (group III). The Tanner stage of pubertal development was delayed relative to chronologic age. Testosterone (T), delta 4-androstenedione (delta 4), and urinary 17-keto steroids were normal when related to pubertal stage in groups I and II; and dehydroepiandrosterone (DHEA) and DHEA sulfate (DS) were in the low normal range. In group III, adrenal androgens (delta 4, DHEA, DS) were decreased as a consequence of prednisone therapy whereas T was normal. Luteinizing hormone levels were normal in all. Follicle-stimulating hormone levels were normal in all. Follicle-stimulating hormone (FSH) was significantly increased in groups I and II. In group III, FSH was normal in 6 of 9 patients with serum creatinine concentrations < 2 mg/dl. FSH levels were uniformly elevated in Tanner I-V patients with creatinines > 2 mg/dl. The data shows that FSH is elevated in patients with chronic renal failure even in prepuberty and early adolescence. This may reflect damage to germinal epithelium prior to the advent of spermatogenesis, whereas Leydig cell function appears to remain intact.
