DELAY OF SEXUAL DEVELOPMENT

DELAY OF SEXUAL DEVELOPMENT

A delay of sexual development is undeveloping of the second sexual signs and absence or rare irregular menstruations in age 15 and more.

Does not follow to equate the delay of sexual development with primary amenorrhea- absence of menarche in age 16 and more years old. Delay of sexual development - a concept is wider and primary amenorrhea often is its symptom.

Cerebral form of delay of sexual development

A delay of sexual development is polyethiologic pathology. Reasons of delay of sexual development can be cerebral violations of organic character: traumatic, toxic, infectious defeats (encephalitis, epilepsy, tumors of hypothalamic area). This pathology of CNS next to expressed nervous-psychical symptoms can entail the delay of sexual development, if the structures of mediobasal hypothalamus are attracted in a process.

To the cerebral forms belong delay of sexual development at psychoses, neuroses as a result of stresses (conflicts are in family, school, emotional overloads). One of cerebral forms of delay of sexual development is anorexia nevrosa, that a waiver is of meal, which is considered as a neurotic reaction in reply to pubertal changes in an organism. This pathology, as a rule, appears for girls with the burdened psychical heredity, in this connection a careful inspection is shown for a psychiatrist.

Constitutional (genetic) delay of sexual development

A delay of sexual development is not the display of some pathology and has the constitutional, inherited, genetically conditioned character.

Girls time-lagged sexual development differ from coevals not only insufficient development of the second sexual signs and аменореєю but also absence of "feminisation of figure", that by the division of fatty and muscular tissue on a womanish type and changes in the structure of pelvis. For girls time-lagged sexual development anthropometric researches are set a eunuch`s build: lengthening hands and feet, relatively short trunk, diminishing of transversal sizes of pelvis. Grew them usually higher, than for coevals. Chronologic age passes ahead biological (bone) age usually.

Hypoplasia of privy parts appears at gynaecological research (sexual infantilism is expressed). External and internal privy parts for patients time-lagged sexual development in 16-18 years answer the state of organs in age 10-11, that to the first phase of pubertal development. Ovaries are formed correctly, but the normal process of foliculogenesis and ovulation does not take place in them.

An exception is made by girls from hyperprolactinaemia (prolactinoma of hypophysis or functional hyperprolactinaemia). For these patients usually the sign of delay of sexual development is primary amenorrhea in combination with unsharply expressed hypoplasia of uterus. A build and length of body answer for them age-old norms, and pectoral glands are developed correctly.

Ovarial form of delay of sexual development

This form is least explored, obviously, in connection with its rareness. At her it is not set chromosomal pathology and changes of maintenance of sexual chromatine. In the structure of ovaries it is not discovered except for diminishing of follicle vehicle, changes. Ovaries are hypoplastic. Possibly, the infectious diseases of children's or toxic influencing which draw violation of follicle vehicle or innervations of ovaries have the defined value in pathogeny of this pathology, that causes change of their sensitiveness to the hormones of stimulants of hypophysis.

For the clinical picture of delay of sexual development there are the personal intersexual touches of build at hypoplastic ovaries. Without regard to the delay of processes of ossification of epiphysis of tubular bones, length of body of girls does not exceed ordinary age-old norms. The second sexual signs are underdeveloped, appears also hypoplasia of external and internal privy parts. Characteristic primary amenorrhea, however there can be liquid and wretched menstruations.

Patients with the delay of sexual development speak to the doctor, as a rule, in age not early than 17-18-th years. To that time they, their parents and, unfortunately, even doctors wait appearances of signs of sexual development. At the inspection of girls time-lagged sexual development it is necessary to use the followings criteria:

· absence of menarche is in age of 16-th years;

· absence of signs of beginning of the sexual ripening in age 13-14-ти years and more;

· absence of menarche during 3th and anymore from the beginning of appearance of development of pectoral glands;

· disparity of indexes of growth and mass of body to chronologic age.

For patients with the delay of sexual development at suspicion on the cerebral forms of pathology a neurological inspection is needed:

· EEG, which allow to differentiate organic or functional violations of cerebral diencephalons structures;

· sciagraphy of skull and Turkish saddle, computer tomography of the Turkish saddle;

· ultrasonic research of organs of small pelvis is for clarification of sizes of uterus and ovaries;

· at presence of additional indexes is laparoscopia with the biopsy of gonads;

· determination of sexual hormones is in the whey of blood;

· sciagraphy of hands is for determination of bone age.

Treatment of central forms of delay of sexual development is a difficult task. In development of complex treatment must take part neurologist. Except for settings of neurologist, cyclic vitamin therapy, and also substitute hormonal therapy is used at hypoplastic ovaries.