DELAYED PUBERTY IN BOYS. MODERN ASPECTS

Abstract

Pubertal impairment in adolescents is an urgent pediatric problem conditioned by progressive worsening of the population’s reproductive health in general. One of the variants of teenagers’ puberty disturbances is the delayed puberty (DP) as no secondary sexual maturation by the age of 14 years in boys. There are discriminated hypogonadism and constitutional DP, the latter being the most frequent form of the disorder of pubertal development in boys, accounting for 60-80% of all forms of DP. At the base of pathogenesis of constitutional DP there are lied deteriorations in the system of the regulation of impulse secretion of gonadotrophin-releasing hormone (Gn-RH) and such non-hormonal factors as monamines of adrenergic and dophaminergic system, melatonin, neuropeptide Y, estragens, insulin-like growth factor-1 (IGF-1), leptine, interacting with Gn-RH-secreting neurons. Pathology of the development and maturation of structures of the diencephalon, as the cause of constitutional APD, is a rather frequent consequence of antenatal and perinatal pathology, traumatic injury of the brain, microcirculatory disorders. DP proves to be an unfavorable factor in the formation of bone density and final growth, in psychological personality achievement of the adolescent, in the maturation of the reproductive system, thus is the subject to correct. The problem of the therapy of constitutional puberty arrest remains to be controversial up to recent time. Some authors adhere to the observation tactics. They believe that children with constitutional DP may have a favorable prognosis of final growth and pubertal development. However, obvious negative psychosocial and medical consequences of the delayed growth and puberty have not yet been taken into consideration. Lately, hormonal therapy with puberty-stimulating steroids, anabolic agents has been suggested. But both a number of questions concerning the effect of therapy with androgens on activation of the hypophyseal-gonadal system in adolescents, and the impact of this treatment on the final growth of the patients remain to be unsolved. The necessity to produce an effect on central mechanisms of regulation by applying physiotherapeutic transcranial techniques, particularly transcranial magnetic therapy also exists. The presented review showed the diversity of factors influencing on the pubertal development of adolescents, various tactical methods of treatment and correction of disorders in patients with constitutional PD.