Constitutional delay of growth and puberty – features of the clinic and diagnosis: Prospective study

Abstract

Aim. To assess clinical, hormonal and metabolic characteristics of adolescent boys with constitutional delay of growth and puberty. Materials and methods. One hundred teenage boys aged 15 were examined. The main group (n=70) patients with constitutional delay of growth and puberty (inclusion criteria: height SDS -2.0 and below, Tanner 1); comparison group (n=30) healthy adolescents of the same age. Objective examination: height SDS score, BMI SDS, puberty score. Laboratory diagnostics: IGF-1, testosterone, luteinizing hormone, follicle-stimulating hormone, inhibin B, anti-Mullerian hormone; stimulating tests: clonidine test, triptorelin test. Instrumental methods: radiography of the bones of the wrist of the left hand with the wrist joint to assess bone age using the GreulichPyle method, ultrasound examination of the scrotum, assessment of the component composition of the body by bioimpedancemetry. Statistical data processing: XL Statistics version 7.0, Microsoft Excel, 2010. Nonparametric statistical methods were used. Data are presented as a median indicating the values of the 1st and 3rd quartiles ([Q1; Q3]), the MannWhitney test was used. Results. Patients with constitutional delay of growth and puberty had significantly lower rates of physical development compared with healthy peers (p=0.003). Most patients of the main group were found to be underweight, accompanied by a persistent decrease in the proportion of active tissues and a significant, paradoxical increase in the proportion of fat mass according to bioimpedancemetry. The identified deviations indicated metabolic disorders and indicated the formation of sarcopenia syndrome in adolescents with CIGR. The level of sex hormones corresponded to the degree of biological immaturity of the patients, low values of inhibin B in combination with an increased level of AMH indicated Sertoli cell deficiency. Conclusion. The pronounced deviations in the clinical, hormonal and metabolic status of patients with constitutional delay of growth and puberty obtained during the study were traced in the clinical picture of most adolescents, which is a significant deviation in the child's health and requires medical correction.