Endocrine Abstracts

Induction of puberty may be required in boys, if puberty is either delayed or arrested. Boys with delayed puberty are often significantly concerned about their physical immaturity, short stature and perceived difference in appearance from peers. The commonest cause of delayed puberty is constitutional delay of growth and puberty (CDGP), a relatively benign condition. However, hypergonadotrophic hypogonadism due to Klinefelter syndrome and hypogonadotrophic hypogonadism (HH) due to brain tumours and Kallmann syndrome, should also be considered in the differential diagnoses. In boys with CDGP, induction of puberty may be beneficial to improve height velocity and pubertal progress, and hence allay anxiety. In children with chronic illnesses causing delayed puberty, induction of puberty may be beneficial to optimise bone mineralisation. Several androgen preparations, administered by varying routes and regimens have been used for the induction of puberty; a short course of injectable testosterone remains the commonest method, with satisfactory puberty and height outcomes achieved in most boys with CDGP. Long acting depot preparations of testosterone may be beneficial in young adults with persistently delayed puberty with likely HH, although injectable gonadotrophin induction of puberty may also be considered.