Pozo Jesús, Argente Jesús
Department of Paediatric Endocrinology, University Autónoma, Hospital Universitario Infantil Niño Jesús, Avda. Menéndez Pelayo 65, E-28009 Madrid, Spain.
Best Pract Res Clin Endocrinol Metab. 2002 Mar;16(1):73-90. doi: 10.1053/beem.2002.0182.
Delayed puberty can be defined as the lack of pubertal development at an age of 2 SD above the mean, which corresponds to an age of approximately 14 years for males and 13 years for females, taking both sex and ethnic origin into consideration. Its incidence associated with chronic illnesses is unknown; however, its clinical importance is relevant due to the larger percentage of patients with chronic disorders surviving until the age of puberty. Virtually every child with any chronic disease could present with delayed puberty (due to recurrent infections, immunodeficiency, gastrointestinal disease, renal disturbances, respiratory illnesses, chronic anaemia, endocrine disease, eating disorders, exercise and a number of miscellaneous abnormalities). Pubertal delay associated with chronic illness is accompanied by a delay in growth and the pubertal growth spurt. The degree to which growth and pubertal development are affected in chronic illness depends upon the type of disease and individual factors, as well as on the age at illness onset, its duration and severity. The earlier its onset and the longer and more severe the illness, the greater the repercussions on growth and pubertal development. The mechanism that trigger the start of physiological puberty remain unknown. Although malnutrition is probably the most important mechanism responsible for delayed puberty, emotional deprivation, toxic substances, stress and the side effects of chronic therapy, among others, have been implicated in the pathophysiology of delayed puberty. Therefore, early diagnosis is essential and appropriate and specific therapy fundamental.
青春期延迟可定义为在高于平均年龄2个标准差时仍未出现青春期发育，考虑到性别和种族因素，这大约相当于男性14岁、女性13岁。其与慢性疾病相关的发病率尚不清楚；然而，由于患有慢性疾病的患者存活至青春期的比例较高，其临床重要性不容忽视。实际上，几乎每一个患有任何慢性疾病的儿童都可能出现青春期延迟（原因包括反复感染、免疫缺陷、胃肠道疾病、肾脏疾病、呼吸系统疾病、慢性贫血、内分泌疾病、饮食失调、运动以及许多其他异常情况）。与慢性疾病相关的青春期延迟会伴有生长延迟和青春期生长突增。慢性疾病对生长和青春期发育的影响程度取决于疾病类型、个体因素，以及发病年龄、病程和严重程度。发病越早、疾病持续时间越长且越严重，对生长和青春期发育的影响就越大。引发生理性青春期开始的机制尚不清楚。尽管营养不良可能是导致青春期延迟的最重要机制，但情感剥夺、有毒物质、压力以及慢性治疗的副作用等也被认为与青春期延迟的病理生理有关。因此，早期诊断至关重要，适当且特定的治疗是根本。
