II. Definition: Hypogonadotropic Hypogonadism
- Decreased functional activity of ovaries or Testes
- Results from pituitary failure to secrete gonadotropins
- Results in delayed Sexual Development and Growth Delay
III. Etiology
- Central defect of Hypothalamic-Pituitary Axis
- Low gonadotropin
IV. General
- Late eunuchoid body proportions
- Grow normally during childhood
- Fail to have pubertal growth spurt
- Growth retardation is recent event
- Plot Growth Velocity!!
V. Causes: Endocrine
- Multiple tropic Hormone deficiency
- Isolated Growth Hormone (Somatotropin) deficiency
- Severe growth retardation (>3 SD from mean)
- Long duration of growth retardation since childhood
- Height Retardation exceeds Weight retardation
- Proportionate dwarfism
- Immature round face
- Mild truncal fat distribution
- Isolated Gonadotropin deficiency
- Kallmann's Syndrome
- Congenital adrenal hypoplasia
- Isolated LH or FSH deficiency
- Other endocrine disorders
- Hypothyroidism
- Diabetes Mellitus
- Glucocorticoid excess (Cushing Syndrome)
- Growth Delay mild if adrenal sex steroid increased
- Hyperprolactinemia
VI. Causes: CNS
- CNS insult due to infection, radiation or Trauma
-
Brain Tumor
- Craniopharygioma
- Astrocytoma
- Hypothalamic glioma
- Pituitary tumor (e.g. Prolactinoma)
VII. Causes: Miscellaneous
- Prader-Willi Syndrome
- Systemic Conditions
- Chronic gastrointestinal conditions
- Chronic Kidney Disease
- Gaucher's Disease
- Cystic Fibrosis
- Sickle Cell Anemia
- Human Immunodeficiency Virus infection
- Medications
- Chronic Opioid use (86% of users)
- Nutritional deficiency OR extreme Energy Expenditure
- Female Athlete Triad
- Psychogenic
- Constitutional Delay in Growth and Development
- Compare siblings and parental growth
- Calculate target height from parental contribution