Induction of puberty is indicated in children with primary or secondary gonadal failure, and where there is pubertal arrest or delay for whatever reason.
Timing of induction will vary depending upon age at presentation/diagnosis, but as far as possible this should coincide with expected pubertal changes within the normal population range.
Optimization of final height, breast and uterine development, and fertility are important outcome considerations and are dependent upon the underlying diagnosis (e.g.Turner syndrome, Klinefelters Syndrome, survivors of childhood cancer).
Indications for pubertal induction in both sexes fall into two main diagnostic categories;
Hypopituitarism (primary & Secondary)
Primary Gonadal failure (dysgenic/syndromic/autoimmune/toxicity)
Specific genetic diagnoses may require disclosure and counciling prior to pubertal induction and ideally require a multidisciplinary team approach.
Protocols for induction of puberty must be individualized as response to sex hormone replacement is very variable and may depend upon the underlying diagnosis.
Puberty may be induced using preparations given by oral, transdermal or intramuscular (Male) routes. Titration of dose is made depending upon individual clinical response with emphasis on mirroring normal pubertal development.
Appropriate monitoring and transition to adult service as appropriate, is an integral part of the induction process.
The role of the Endocrine clinical nurse specialist is crucial to this process and for optimum transition to long term adult follow-up.