delayed puberty
Introduction
Introduction to adolescent stunting Adolescent stunting is also known as delayed menarche. About 1% of girls do not have menstruation in 18-year-old fashion, and then mature gradually, so it is difficult to define stunting. Currently, they tend to be completely non-sexual at 16 years old, or 18 years old. In the absence of menstruation, it is stunted or primary amenorrhea. The clinical weight is significantly lower than the normal average, the subcutaneous fat layer is meager, and the anorexia is manifested. For example, the thyroid function is low, and there may be various manifestations such as low systemic metabolism, and the pineal tumor causes the melatonin to increase. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: developmental delay
Cause
Adolescent growth retardation
Causes
Physical or idiopathic puberty retardation (50%):
Can not find any cause of developmental delay, and eventually can develop normal, family-oriented. Nutritional factors, menarche is related to the amount of fat in the body. When the body fat increases to 17% of body weight, menarche, underweight, adolescent anorexia nervosa, and weight loss during high-volume training are delayed.
Pathological developmental delay (30%):
Due to systemic malnutrition, chronic diseases, chemotherapy during adolescence, trauma, mood depression or adolescent endocrine diseases, pineal tumors are rare, and women are rare.
Hypothyroidism (10%):
The pronunciation is often delayed and is associated with low systemic metabolism.
Pathogenesis
Delay in puberty development is due to the lack of estrogen in the body, and the lack of estrogen is due to the ovarian, or the hypothalamic function of the ovarian function, or the functional state of the pituitary gland. The mechanism of puberty development is still unclear, and the constitutional growth retardation is unclear. The pathogenesis is also unclear. However, similar to precocious puberty, genetic factors, environment, and general health status are related to the pathogenesis.
Pineal tumors produce increased melatonin, which affects gonadotropin secretion and delays development or hypogonadism.
Prevention
Adolescent growth retardation prevention 1. Maintain an optimistic and happy mood. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood. 2, life restraint pay attention to rest, work and rest, life orderly, maintain an optimistic, positive, upward attitude towards life has a great help to prevent disease. Do the regularity of tea and rice, live daily, not overworked, open-minded, and develop good habits. 3, reasonable diet can eat more high-fiber and fresh vegetables and fruits, balanced nutrition, including protein, sugar, fat, vitamins, trace elements and dietary fiber and other essential nutrients, meat and vegetables, diversified food varieties, Giving full play to the complementary role of nutrients in food is also helpful in preventing this disease.
Complication
Adolescent growth retardation complications Complications, stunting
1. Physical development is backward.
2, sports development is backward.
3. Language development is backward.
4. Mental development is backward.
Symptom
Symptoms of adolescent stunting Common symptoms Hypothyroidism Low systemic metabolism Low melatonin Anorexia Adolescent chest development slow
16 years old without sexual development, 18 years old without menstrual sexual dysplasia, Deuhurst also proposed: boys do not appear secondary sexual development at the age of 16, girls do not appear secondary sexual development at 15 years of age can be called puberty and sexual development retardation, although There are differences in the age standard, but in general, sexual growth retardation refers to the occurrence of sexual characteristics and the development of sexual characteristics are not normal. In short, children do not have secondary sexual characteristics in the age range of puberty, or Bisexuality, but the progress is very slow, all are puberty retardation, caused by nutritional factors, clinical weight is significantly lower than the normal mean, subcutaneous fat layer is thin, anorexia performance, such as by hypothyroidism, may have systemic metabolism Such as various manifestations, caused by pineal tumors, increased melatonin and other manifestations.
Examine
Examination of puberty retardation
(1) Laboratory inspection
1. Blood, urine routine, erythrocyte sedimentation rate, liver and kidney function tests: can understand the whole body condition, if necessary, measure blood sugar, urine sugar, liver and kidney function.
2. Endocrine hormone test: mainly measures gonadotropin (FSH, LH) and sex hormones (estradiol, testosterone). At the onset of normal puberty, LH secretion increased at night, so the determination of LH at night was more diagnostic. The GnRH stimulation test is of great value in identifying physical and pathological puberty delays and identifying pituitary or hypothalamic lesions. Normally, after intravenous injection of GnRH, subjects developed age-adapted plasma LH and FSH responses. In patients with primary sexual dysfunction and Turner syndrome, the response is enhanced, hypothalamic and pituitary dysfunction is reduced, and in patients with delayed puberty development, the reactivity is compatible with their bone age.
(2) Other auxiliary inspections
X-ray inspection
Determination of bone age by wrist plain film should be classified as routine examination, because the correlation between puberty onset and bone age is significantly related to its actual age. Head X-ray examination, most of the craniopharyngioma have abnormalities in the sellar region, and 70% of them show calcification, so the lateral plain film examination can help diagnose.
2.B-ultrasound
Men can understand the testicular and spermatic veins, women can understand the size of the ovary, morphology and uterus development, but also help the diagnosis of other abdominal diseases.
3. CT and MRI examination
CT and MRI have important diagnostic value for central nervous tumors.
4. Chromosome examination
For gonad hypoplasia or some special facial signs, it is often suggested that karyotype analysis is required.
5. Laparoscopy and gonadal biopsy
For those suspected of having ovarian lesions (such as ovarian dysplasia or tumor), laparoscopic examination and gonad biopsy may be appropriate if necessary.
Diagnosis
Diagnosis and diagnosis of puberty retardation
diagnosis
Can be diagnosed based on clinical manifestations.
Differential diagnosis
According to clinical manifestations, developmental delay can be found, but it needs to be differentiated from gonadal dysplasia.
1. Peripheral blood karyotype examination: developmental delay, normal sex chromosomes (46xx), gonadal dysplasia, can be 45xO and its chimeric type, 46xi, 46xxr or 46xy.
2. Determination of blood hormone: Ovarian dysplasia, LH, FSH increased, E2 is low, LH, FSH and E2 are low, but there is a change in follow-up.
3. Pathological growth retardation: the performance of the primary disease.
