ESPE Abstracts

Delayed puberty (DP) is defined as a retardation of sexual maturation beyond the expected age, which conventionally is between 8 and 13 years in females. Since DP due to hypogonadism requires a specific treatment, it is crucial to promptly define the underlying pathogenesis and identify a tailored program of care. Hormonal therapy is essential to promote the development of secondary sexual characteristics, bone, muscle, and social, sexual, and psychologic skills. Despite the optimal age to start treatment has not been universally established yet, in order to recapitulate physiology pubertal induction should be considered at 11 years in girls with known hypogonadism or otherwise as soon as such diagnosis is established, avoiding to delay treatment too long beyond the age of 13 even when constitutional delay of puberty is suspected. In females, adequate pubertal development is achieved with progressively increasing doses of estrogens alone, while the main role of progesterone is to prevent endometrial hyperplasia. Several studies have proposed different therapeutic regimens for pubertal induction, which differ in formulation, duration, initial dose and subsequent augmentation, and timing of progestin introduction: however, the best approach has not been defined yet. Puberty should be induced over a period of 2–4 years until a satisfactory outcome is achieved, usually when an adult dose has been reached. Puberty induction in late-diagnosed patients must be individualized and a faster tempo in the increase of estrogen doses can be considered. Therapy should involve 17βestradiol and most Authors currently recommend transdermal estradiol as the first choice. Most of the recommendations regarding estrogen dosing are based on data extrapolated from girls with Turner Syndrome and Literature sources are scant regarding other etiologies of female hypogonadism. Hence, it is mandatory to encompass the heterogeneity of the population to treat and underline the key differences in therapeutic timing and goals.