Puberty in chronic inflammatory conditions

Abstract

Puberty in chronic conditions may be severely delayed or arrested, with resultant poor linear growth, potential truncation of final height, and reduced peak bone mass, thus significantly increasing osteoporosis risk throughout adulthood. Systemic inflammatory cytokines, malnutrition, and use of glucocorticoids all affect the hypothalamic pituitary gonadal axis. Endocrine outcomes are influenced by ability to reduce disease activity and relapse. Introduction of new therapeutic agents with promising results, together with improvements in nutritional management and reduction of glucocorticoids, has changed the trajectory of many chronic inflammatory conditions. However, despite therapeutic improvement occurring over recent years, pubertal delay remains a frequent complication. Timely and repeated assessment and intervention is imperative, to avoid short- and long-term adverse consequences of lack of appropriate sex steroids on linear growth, pubertal maturation, psychosocial and emotional maturity.