Constitutional Delay

Question 1

most common cause

Answer 1

functional GnRH deficiency

Question 2

Basic Diagnostics

Answer 2

bone age
FSH, LH
E2

Question 3

If hypo-hypo or hyper-hypo

Answer 3

Hypo hypo: PRL, TSH, brain MRI with GAD, DHEAS, CBC, ESR, LFT, pelvic UTZ
hyper-hypo karyotype

Question 4

therapuetics

Answer 4

induction of puberty using estrogen after 12 yo

0.25-0.5 mg micronized E2 or its equivalent oral or transdermal

monitor q3-6 months with bone age and tanner

then add progestin after 12-24months or once with menses

GOAL: sexual maturation in 2-3 years

Question 5

causes

Answer 5

functional gnrh deficiency
suppression c/o chronic stress
malnutrition
excessive exercise
genetic defect
anatomic

Question 6

target height

Answer 6

midparental height +/- 8.5 cm

(fathers-13 + mama) /2