Unit of Pediatrics and Pediatric Emergency, Children's Hospital, SS Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy.
Department of Pediatrics, "V. Buzzi" Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy.
Minerva Pediatr (Torino). 2021 Dec;73(6):572-587. doi: 10.23736/S2724-5276.21.06534-4. Epub 2021 Jul 26.
Subjects with hypo- or hypergonadotropic hypogonadism need hormone replacement therapy (HRT) to initiate puberty and maintain it with a normal hormonal status. While general recommendations for the management of HRT in adults have been published, no systematic suggestions focused on adolescents and young adults. The focus of this review is the HRT in males and females with hypogonadism, from puberty to late reproductive age, covering the different management options, encompassing sex steroid or gonadotropin therapy, with discussion of benefits, limitations and specific considerations of the different treatments.
We conducted an extensive search in the 3 major scientific databases (PubMed, EMBASE and Google Scholar) using the keywords "hormonal replacement therapy," "hypogonadism," "bone mineral density," "estradiol/testosterone," "puberty induction," "delayed puberty." Case-control studies, case series, reviews and meta-analysis published in English from 1990 to date were included.
By considering the available opportunities for fertility induction and preservation, we hereby present the proposals of practical schemes to induce puberty, and a decisional algorithm to approach HRT in postpubertal adolescents.
A condition of hypogonadism can underlie different etiologies involving the hypothalamic-pituitary-gonadal axis at different levels. Since the long-terms effects of hypogonadism may vary and include not only physical outcomes related to sex hormone deficiencies, but also psychological problems and implications on fertility, the initiation, maintenance and consolidation of puberty with different pharmaceutical options is of utmost importance and beside pubertal development, optimal uterine and testicular growth and adequate bone health should consider also the psychosocial wellbeing and the potential fertility.
患有低促性腺激素或高促性腺激素性腺功能减退症的患者需要激素替代疗法（HRT）来启动青春期，并保持正常的激素状态。虽然已经发布了成人 HRT 管理的一般建议，但没有针对青少年和年轻成年人的系统建议。本综述的重点是患有性腺功能减退症的男性和女性的 HRT，从青春期到生殖后期，涵盖了不同的管理选择，包括性激素或促性腺激素治疗，并讨论了不同治疗方法的益处、局限性和特定考虑因素。
我们在三个主要科学数据库（PubMed、EMBASE 和 Google Scholar）中使用关键词“激素替代疗法”、“性腺功能减退症”、“骨矿物质密度”、“雌二醇/睾酮”、“青春期诱导”、“青春期延迟”进行了广泛搜索。纳入了自 1990 年以来以英文发表的病例对照研究、病例系列研究、综述和荟萃分析。
通过考虑到诱导和保存生育力的现有机会，我们提出了实用方案来诱导青春期的建议，并提出了一种用于治疗青春期后青少年 HRT 的决策算法。
性腺功能减退症可能是下丘脑-垂体-性腺轴在不同水平上的不同病因引起的。由于性腺功能减退症的长期影响可能不同，不仅包括与性激素缺乏相关的身体结果，还包括心理问题和对生育能力的影响，因此，使用不同的药物选择启动、维持和巩固青春期至关重要，除了青春期发育外，还应考虑到子宫和睾丸的最佳生长以及充足的骨骼健康，还应考虑到心理健康和潜在的生育能力。
