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Absence of pubertal development

MedGen UID:
375841
Concept ID:
C1846228
Finding
HPO: HP:0008197

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVAbsence of pubertal development

Conditions with this feature

46,XY sex reversal 11
MedGen UID:
78602
Concept ID:
C0266427
Disease or Syndrome
SRXY11 is characterized by a genital phenotype that may range from predominantly female to predominantly male, including marked sex ambiguity depending on the duration of normal testicular function prior to the loss of testicular tissue. Approximately half of patients present with micropenis and bilateral cryptorchidism, and half present with female-appearing or ambiguous external genitalia (da Silva et al., 2019; McElreavey et al., 2020). The testicular regression syndrome (TRS) was delineated by Sarto and Opitz (1973), who called it the XY gonadal dysgenesis syndrome. It is characterized primarily by the absence of gonads in an XY person. In most cases, uterus and fallopian tubes are absent but small tubular structures interpreted as mullerian or wolffian rudiments (or both) are present. The range of virilizing effects due to early testicular tissue extends from none in phenotypic females with only slightly hypoplastic normal external genitalia, well-formed but hypoplastic uterus, and well-formed tubes (De Marchi et al., 1981) to the anorchic phenotypic male (Edman et al., 1977). Most affected individuals lack a vagina but a urogenital sinus or pseudovaginal urethral outpouching is found. Partial labioscrotal fusion and clitoris enlargement are common, breast development is absent, and postpubertal eunuchoid habitus is the rule. Sometimes nongenital anomalies are present (summary by Rosenberg et al., 1984).
Congenital adrenal hypoplasia, X-linked
MedGen UID:
87442
Concept ID:
C0342482
Disease or Syndrome
NR0B1-related adrenal hypoplasia congenita includes both X-linked adrenal hypoplasia congenita (X-linked AHC) and Xp21 deletion (previously called complex glycerol kinase deficiency). X-linked AHC is characterized by primary adrenal insufficiency and/or hypogonadotropic hypogonadism (HH). Adrenal insufficiency is acute infantile onset (average age 3 weeks) in approximately 60% of affected males and childhood onset (ages 1-9 years) in approximately 40%. HH typically manifests in a male with adrenal insufficiency as delayed puberty (i.e., onset age >14 years) and less commonly as arrested puberty at about Tanner Stage 3. Rarely, X-linked AHC manifests initially in early adulthood as delayed-onset adrenal insufficiency, partial HH, and/or infertility. Heterozygous females very occasionally have manifestations of adrenal insufficiency or hypogonadotropic hypogonadism. Xp21 deletion includes deletion of NR0B1 (causing X-linked AHC) and GK (causing glycerol kinase deficiency), and in some cases deletion of DMD (causing Duchenne muscular dystrophy). Developmental delay has been reported in males with Xp21 deletion when the deletion extends proximally to include DMD or when larger deletions extend distally to include IL1RAPL1 and DMD.
Cerebellar ataxia-hypogonadism syndrome
MedGen UID:
349137
Concept ID:
C1859305
Disease or Syndrome
PNPLA6 disorders span a phenotypic continuum characterized by variable combinations of cerebellar ataxia; upper motor neuron involvement manifesting as spasticity and/or brisk reflexes; chorioretinal dystrophy associated with variable degrees of reduced visual function; and hypogonadotropic hypogonadism (delayed puberty and lack of secondary sex characteristics). The hypogonadotropic hypogonadism occurs either in isolation or as part of anterior hypopituitarism (growth hormone, thyroid hormone, or gonadotropin deficiencies). Common but less frequent features are peripheral neuropathy (usually of axonal type manifesting as reduced distal reflexes, diminished vibratory sensation, and/or distal muscle wasting); hair anomalies (long eyelashes, bushy eyebrows, or scalp alopecia); short stature; and impaired cognitive functioning (learning disabilities in children; deficits in attention, visuospatial abilities, and recall in adults). Some of these features can occur in distinct clusters on the phenotypic continuum: Boucher-Neuhäuser syndrome (cerebellar ataxia, chorioretinal dystrophy, and hypogonadotropic hypogonadism); Gordon Holmes syndrome (cerebellar ataxia, hypogonadotropic hypogonadism, and – to a variable degree – brisk reflexes); Oliver-McFarlane syndrome (trichomegaly, chorioretinal dystrophy, short stature, intellectual disability, and hypopituitarism); Laurence-Moon syndrome; and spastic paraplegia type 39 (SPG39) (upper motor neuron involvement, peripheral neuropathy, and sometimes reduced cognitive functioning and/or cerebellar ataxia).
Hypogonadotropic hypogonadism 4 with or without anosmia
MedGen UID:
765257
Concept ID:
C3552343
Disease or Syndrome
Isolated gonadotropin-releasing hormone (GnRH) deficiency (IGD) is characterized by inappropriately low serum concentrations of the gonadotropins LH (luteinizing hormone) and FSH (follicle-stimulating hormone) in the presence of low circulating concentrations of sex steroids. IGD is associated with a normal sense of smell (normosmic IGD) in approximately 40% of affected individuals and an impaired sense of smell (Kallmann syndrome) in approximately 60%. IGD can first become apparent in infancy, adolescence, or adulthood. Infant boys with congenital IGD often have micropenis and cryptorchidism. Adolescents and adults with IGD have clinical evidence of hypogonadism and incomplete sexual maturation on physical examination. Adult males with IGD tend to have prepubertal testicular volume (i.e., <4 mL), absence of secondary sexual features (e.g., facial and axillary hair growth, deepening of the voice), decreased muscle mass, diminished libido, erectile dysfunction, and infertility. Adult females have little or no breast development and primary amenorrhea. Although skeletal maturation is delayed, the rate of linear growth is usually normal except for the absence of a distinct pubertal growth spurt.
Hypogonadotropic hypogonadism 8 with or without anosmia
MedGen UID:
766755
Concept ID:
C3553841
Disease or Syndrome
Isolated gonadotropin-releasing hormone (GnRH) deficiency (IGD) is characterized by inappropriately low serum concentrations of the gonadotropins LH (luteinizing hormone) and FSH (follicle-stimulating hormone) in the presence of low circulating concentrations of sex steroids. IGD is associated with a normal sense of smell (normosmic IGD) in approximately 40% of affected individuals and an impaired sense of smell (Kallmann syndrome) in approximately 60%. IGD can first become apparent in infancy, adolescence, or adulthood. Infant boys with congenital IGD often have micropenis and cryptorchidism. Adolescents and adults with IGD have clinical evidence of hypogonadism and incomplete sexual maturation on physical examination. Adult males with IGD tend to have prepubertal testicular volume (i.e., <4 mL), absence of secondary sexual features (e.g., facial and axillary hair growth, deepening of the voice), decreased muscle mass, diminished libido, erectile dysfunction, and infertility. Adult females have little or no breast development and primary amenorrhea. Although skeletal maturation is delayed, the rate of linear growth is usually normal except for the absence of a distinct pubertal growth spurt.
Hypogonadotropic hypogonadism 11 with or without anosmia
MedGen UID:
766758
Concept ID:
C3553844
Disease or Syndrome
Isolated gonadotropin-releasing hormone (GnRH) deficiency (IGD) is characterized by inappropriately low serum concentrations of the gonadotropins LH (luteinizing hormone) and FSH (follicle-stimulating hormone) in the presence of low circulating concentrations of sex steroids. IGD is associated with a normal sense of smell (normosmic IGD) in approximately 40% of affected individuals and an impaired sense of smell (Kallmann syndrome) in approximately 60%. IGD can first become apparent in infancy, adolescence, or adulthood. Infant boys with congenital IGD often have micropenis and cryptorchidism. Adolescents and adults with IGD have clinical evidence of hypogonadism and incomplete sexual maturation on physical examination. Adult males with IGD tend to have prepubertal testicular volume (i.e., <4 mL), absence of secondary sexual features (e.g., facial and axillary hair growth, deepening of the voice), decreased muscle mass, diminished libido, erectile dysfunction, and infertility. Adult females have little or no breast development and primary amenorrhea. Although skeletal maturation is delayed, the rate of linear growth is usually normal except for the absence of a distinct pubertal growth spurt.
Hypogonadotropic hypogonadism 18 with or without anosmia
MedGen UID:
815305
Concept ID:
C3808975
Disease or Syndrome
Isolated gonadotropin-releasing hormone (GnRH) deficiency (IGD) is characterized by inappropriately low serum concentrations of the gonadotropins LH (luteinizing hormone) and FSH (follicle-stimulating hormone) in the presence of low circulating concentrations of sex steroids. IGD is associated with a normal sense of smell (normosmic IGD) in approximately 40% of affected individuals and an impaired sense of smell (Kallmann syndrome) in approximately 60%. IGD can first become apparent in infancy, adolescence, or adulthood. Infant boys with congenital IGD often have micropenis and cryptorchidism. Adolescents and adults with IGD have clinical evidence of hypogonadism and incomplete sexual maturation on physical examination. Adult males with IGD tend to have prepubertal testicular volume (i.e., <4 mL), absence of secondary sexual features (e.g., facial and axillary hair growth, deepening of the voice), decreased muscle mass, diminished libido, erectile dysfunction, and infertility. Adult females have little or no breast development and primary amenorrhea. Although skeletal maturation is delayed, the rate of linear growth is usually normal except for the absence of a distinct pubertal growth spurt.
Ovarian dysgenesis 6
MedGen UID:
1648307
Concept ID:
C4748084
Disease or Syndrome
Ovarian dysgenesis-6 is characterized by absence of spontaneous pubertal development in females with elevated gonadotropin levels, small uterus, and absence of ovarian tissue on imaging studies. Males appear to be unaffected (Weinberg-Shukron et al., 2015). For a discussion of genetic heterogeneity of ovarian dysgenesis, see ODG1 (233300).
Hypogonadotropic hypogonadism 27 without anosmia
MedGen UID:
1810165
Concept ID:
C5676921
Disease or Syndrome
Hypogonadotropic hypogonadism-27 without anosmia (HH27) is characterized by lack of pubertal development associated with onset of obesity in early adolescence (Topaloglu et al., 2022). Congenital idiopathic hypogonadotropic hypogonadism (IHH) is a disorder characterized by absent or incomplete sexual maturation by the age of 18 years, in conjunction with low levels of circulating gonadotropins and testosterone and no other abnormalities of the hypothalamic-pituitary axis. Idiopathic hypogonadotropic hypogonadism can be caused by an isolated defect in gonadotropin-releasing hormone (GNRH; 152760) release, action, or both. Other associated nonreproductive phenotypes, such as anosmia, cleft palate, and sensorineural hearing loss, occur with variable frequency. In the presence of anosmia, idiopathic hypogonadotropic hypogonadism has been called 'Kallmann syndrome (KS),' whereas in the presence of a normal sense of smell, it has been termed 'normosmic idiopathic hypogonadotropic hypogonadism (nIHH)' (summary by Raivio et al., 2007). Because families have been found to segregate both KS and nIHH, the disorder is here referred to as 'hypogonadotropic hypogonadism with or without anosmia (HH).'

Professional guidelines

PubMed

Pozo J, Argente J
Horm Res 2003;60 Suppl 3:35-48. doi: 10.1159/000074498. PMID: 14671394

Recent clinical studies

Etiology

Rodprasert W, Virtanen HE, Toppari J
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Patti G, Scaglione M, Maiorano NG, Rosti G, Divizia MT, Camia T, De Rose EL, Zucconi A, Casalini E, Napoli F, Di Iorgi N, Maghnie M
Front Endocrinol (Lausanne) 2023;14:1213098. Epub 2023 Jul 28 doi: 10.3389/fendo.2023.1213098. PMID: 37576960Free PMC Article
Bouhuys M, Lexmond WS, van Rheenen PF
Pediatrics 2023 Jan 1;151(1) doi: 10.1542/peds.2022-058037. PMID: 36545774
Klein DA, Paradise SL, Reeder RM
Am Fam Physician 2019 Jul 1;100(1):39-48. PMID: 31259490
Morgan T
Am Fam Physician 2007 Aug 1;76(3):405-10. PMID: 17708142

Diagnosis

Moise-Silverman J, Silverman LA
Front Endocrinol (Lausanne) 2022;13:1029137. Epub 2022 Dec 2 doi: 10.3389/fendo.2022.1029137. PMID: 36531492Free PMC Article
Seppä S, Kuiri-Hänninen T, Holopainen E, Voutilainen R
Eur J Endocrinol 2021 May 4;184(6):R225-R242. doi: 10.1530/EJE-20-1487. PMID: 33687345
Butler G, Purushothaman P
Minerva Pediatr 2020 Dec;72(6):484-490. Epub 2020 Aug 4 doi: 10.23736/S0026-4946.20.05968-X. PMID: 32748610
Klein DA, Paradise SL, Reeder RM
Am Fam Physician 2019 Jul 1;100(1):39-48. PMID: 31259490
Sultan C, Gaspari L, Maimoun L, Kalfa N, Paris F
Best Pract Res Clin Obstet Gynaecol 2018 Apr;48:62-89. Epub 2017 Nov 14 doi: 10.1016/j.bpobgyn.2017.11.004. PMID: 29422239

Therapy

Cardona-Hernandez R, Dôvc K, Biester T, Ekhlaspour L, Macedoni M, Tauschmann M, Mameli C
Pharmacol Res 2023 Sep;195:106882. Epub 2023 Aug 3 doi: 10.1016/j.phrs.2023.106882. PMID: 37543096
Manique MES, Ferreira AMAP
Rev Bras Ginecol Obstet 2022 Apr;44(4):425-433. Epub 2022 May 27 doi: 10.1055/s-0042-1742292. PMID: 35623621Free PMC Article
Wit JM
Front Endocrinol (Lausanne) 2021;12:812196. Epub 2021 Dec 16 doi: 10.3389/fendo.2021.812196. PMID: 34975773Free PMC Article
Patisaul HB, Fenton SE, Aylor D
Best Pract Res Clin Endocrinol Metab 2018 Jun;32(3):283-297. Epub 2018 Apr 6 doi: 10.1016/j.beem.2018.03.011. PMID: 29779582Free PMC Article
Morgan T
Am Fam Physician 2007 Aug 1;76(3):405-10. PMID: 17708142

Prognosis

Mohanraj S, Prasad HK
Indian J Pediatr 2023 Jun;90(6):590-597. Epub 2023 May 2 doi: 10.1007/s12098-023-04577-x. PMID: 37127825
Bouhuys M, Lexmond WS, van Rheenen PF
Pediatrics 2023 Jan 1;151(1) doi: 10.1542/peds.2022-058037. PMID: 36545774
Calcaterra V, Rossi V, Massini G, Regalbuto C, Hruby C, Panelli S, Bandi C, Zuccotti G
Front Endocrinol (Lausanne) 2022;13:1000919. Epub 2022 Oct 21 doi: 10.3389/fendo.2022.1000919. PMID: 36339428Free PMC Article
Wit JM
Front Endocrinol (Lausanne) 2021;12:812196. Epub 2021 Dec 16 doi: 10.3389/fendo.2021.812196. PMID: 34975773Free PMC Article
Butler G, Purushothaman P
Minerva Pediatr 2020 Dec;72(6):484-490. Epub 2020 Aug 4 doi: 10.23736/S0026-4946.20.05968-X. PMID: 32748610

Clinical prediction guides

Bouhuys M, Lexmond WS, van Rheenen PF
Pediatrics 2023 Jan 1;151(1) doi: 10.1542/peds.2022-058037. PMID: 36545774
Calcaterra V, Rossi V, Massini G, Regalbuto C, Hruby C, Panelli S, Bandi C, Zuccotti G
Front Endocrinol (Lausanne) 2022;13:1000919. Epub 2022 Oct 21 doi: 10.3389/fendo.2022.1000919. PMID: 36339428Free PMC Article
Palumbo S, Cirillo G, Aiello F, Papparella A, Miraglia Del Giudice E, Grandone A
Front Endocrinol (Lausanne) 2022;13:991322. Epub 2022 Sep 16 doi: 10.3389/fendo.2022.991322. PMID: 36187104Free PMC Article
Wit JM
Front Endocrinol (Lausanne) 2021;12:812196. Epub 2021 Dec 16 doi: 10.3389/fendo.2021.812196. PMID: 34975773Free PMC Article
Butler G, Purushothaman P
Minerva Pediatr 2020 Dec;72(6):484-490. Epub 2020 Aug 4 doi: 10.23736/S0026-4946.20.05968-X. PMID: 32748610

Recent systematic reviews

Patti G, Scaglione M, Maiorano NG, Rosti G, Divizia MT, Camia T, De Rose EL, Zucconi A, Casalini E, Napoli F, Di Iorgi N, Maghnie M
Front Endocrinol (Lausanne) 2023;14:1213098. Epub 2023 Jul 28 doi: 10.3389/fendo.2023.1213098. PMID: 37576960Free PMC Article
Shu W, Zong X, Li H
Front Endocrinol (Lausanne) 2022;13:1042122. Epub 2022 Nov 24 doi: 10.3389/fendo.2022.1042122. PMID: 36506059Free PMC Article
Lee YJ, Jung HW, Kim HY, Choi YJ, Lee YA
Front Endocrinol (Lausanne) 2021;12:683297. Epub 2021 Sep 9 doi: 10.3389/fendo.2021.683297. PMID: 34566884Free PMC Article
Holden S, Boreham C, Delahunt E
Sports Med 2016 Feb;46(2):241-53. doi: 10.1007/s40279-015-0416-6. PMID: 26542164

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