N.V. BOLOTOVA, N.Yu. FILINA, K.A. CHEREDNIKOVA, V.K. POLYAKOV, A.P. AVERYANOV

Saratov State Medical University named after V.I. Razumovsky, Saratov

Contact deatils:

Bolotova N.V. – MD, Professor, Head of the Department of Propaedeutics of Children’s Diseases, Pediatric Endocrinology and Diabetology

Address: 137 Bolshaya Sadovaya Str., 410054, Saratov, tel. +7-903-328-79-92, e-mail: kafedranv@mail.ru

 Constitutional delay of growth and puberty is one of the most common forms of stunting. Currently, there is no uniform approach to treatment of this disorder.

Objective: to evaluate the clinical and hormonal features of adolescent boys of different ages with constitutional delay of growth and puberty in order to optimize the tactics of their treatment. Material and methods: a clinical-laboratory examination of 70 boys with constitutional delay of growth and puberty was conducted. The patients were divided into two subgroups: subgroup 1A – 14 year olds (n = 40) and subgroup 1B – 15 year olds (n = 30). The control group was 30 practically healthy boys of 14 and 15 years (subgroup 2A (n = 15) – 14 y.o., subgroup 2B (n = 15) – 15 y.o.) with normal growth and pubertal development. The complaints and anamnesis were collected, genetic maps was studied. Physical (SDS growth, SDS BMI), pubertal development (Tanner scale), and bone age were evaluated. The laboratory diagnostics of the level of blood hormones was performed: thyroid-stimulating hormone, thyroxine, Prolactin, luteinizing hormone, follicle-stimulating hormone, total testosterone, inhibin B, antimueller hormone. To eliminate the growth hormone deficiency, STG-stimulating tests were performed.

Results: the results of the clinical examination indicate an increase in the delay in 15 y. o. patients with constitutional delay of growth and puberty by both SDS growth and SDS BMI. The hormonal profile of patients with constitutional delay of growth and puberty showed a decrease in prolactin, sex hormones and IGF-1. At the same time, the degree of testosterone and LH lagging increases with the age of patients. When assessing the markers of Sertoli cells, the level of inhibin B in patients with constitutional delay of growth and puberty was significantly lower than in the control subgroups. The level of AMH in both main subgroups was significantly higher than in the control subgroups, with a trend towards an increase in AMH levels in 15-year-old patients with constitutional delay of growth and puberty, which together with a reduced level of inhibin B in the same patients may indicate a disruption in the accumulation and maturation of Sertoli cells in patients with a long delay in puberty.

 Conclusions: According to the results of the dynamic objective clinical and laboratory examination, 15-year-old patients with a long history of growth delay, a low level of IGF-1 and inhibin B are in the risk group requiring initiation of pubertal therapy.

Key words: growth delay, puberty delay, growth hormone, testosterone, inhibin B.

(For citation: Bolotova N.V., Filina N.Yu., Cherednikova K.A., Polyakov V.K., Averyanov A.P. Clinical and hormonal features of patients with constitutional delay of growth and puberty. Practical Medicine. 2019, Vol. 17, № 5, P. 60-67)

REFERENCES

1. Kasatkina E.P. Zaderzhka rosta u detey: differentsial’naya diagnostika i lechenie [Growth retardation in children: differential diagnosis and treatment]. Moscow: IMA-press; 2003. P. 24.
2. Dedov I.I., Semicheva T.V., Peterkova V.A. Polovoe razvitie detey: norma i patologiya [Sexual development of children: norm and pathology]. Moscow: Kolor It Studio, 2002. P. 232.
3. Shandin A.N. Klinicheskie varianty i molekulyarnye osnovy idiopaticheskoy nizkoroslosti u detey: dis. … kand. med. nauk [Clinical options and molecular foundations of idiopathic short stature in children. Dis. PhD med. sciences]. Moscow, 2011.
4. Atanesyan R.A. Diagnostika i sovremennye aspekty lecheniya zaderzhki rosta razlichnogo geneza u detey: dis. … kand. med. nauk [Diagnosis and modern aspects of the treatment of growth retardation of various origins in children. Dis. PhD med. sciences]. Stavropol, 2014.
5. Pushkina S.A. Metabolizm kostnoy tkani pri zaderzhke rosta u detey: avtoref. dis. … kand. med. nauk [Bone metabolism in children with growth retardation. Synopsis Dis. PhD med. sciences]. Izhevsk, 2004.
6. Kuchumova O.V. Faktory riska i kliniko-patogeneticheskaya kharakteristika razlichnykh form nizkoroslosti u detey: avtoref. dis. … kand. med. nauk [Risk factors and clinical and pathogenetic characteristics of various forms of stunting in children. Synopsis Dis. PhD med. sciences]. Samara, 2008.
7. Shabalov N.P. Diagnostika i lechenie endokrinnykh zabolevaniy u detey i podrostkov: uchebnoe posobie [Diagnosis and treatment of endocrine diseases in children and adolescents: a training manual]. Moscow: MED press-inform, 2009.
8. Sinitsyn. P.A., Shcherbakova M.Yu., Larionova V.I. et al. Metabolic syndrome in children. Pediatriya. Zhurnal im. N.G. Speranskogo, 2008, vol. 87, no. 5, pp. 124-127 (in Russ.).
9. Zakharova N.B., Ivanenko I.L., Bolotova N.V. et al. The functional state of the hypothalamic-pituitary-gonadal system of healthy boys 1-3 months (mini-puberty). Meditsinskiy alfavit, 2013, no. 2, pp. 22-24 (in Russ.).
10. Josso N, Legeai L, Forest MG et al. An enzyme linked immunoassay for anti-Mullerian hormone: New tool for the evaluation of testicular function in infants and children. J Clin Endocrinol Metab, 1990; 70(1): 23–7. doi: 10.1210/jcem-70-1-23
11. Smirnov V.V., Makazan N.V. Functional delay in sexual development: causes, diagnosis, treatment. Lechashchiy vrach, 2012, no. 1, p. 30 (in Russ.).
12. Crowne E.C., Shalet S.M., Wallace W.H. et al. Final height in boys with untreated constitutional delay in growth and puberty. Archives of Disease in Childhood, 1990, vol. 65, pp. 1109-1112.
13. Stanhope R., Fry V. Constitutional Delay of Growth and Puberty. The child growth foundation, 2000, vol. 10, pp. 9-10.
14. Rohayem J., Nieschlag E., Kliesch S. et al. Inhibin B, AMH, but not INSL3, IGF1 or DHEAS support differentiation between constitutional delay of growth and puberty and hypogonadotropic hypogonadism. Andrology, 2015, vol. 3, no. 5, pp. 882–887. doi:10.1111/andr.12088
15. Harrington J., Palmert M.R. Clinical review: Distinguishing Constitutional Delay of Growth and Puberty from Isolated Hypogonadotropic Hypogonadism: Critical Appraisal of Available Diagnostic Tests. J Clin Endocrinol Metab, 2012, vol. 97, no. 9, pp. 3056–3067. doi: 10.1210/jc.2012-1598