To induce or not to induce - that is the question. delayed puberty in a male with anorexia and ARFID - a case report and literature review

Catriona McKay; Noina Abid; Linda Agnew; Katherine Murtagh

doi:10.1530/endoabs.111.P54

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Endocrine Abstracts (2025) 111 P54 | DOI: 10.1530/endoabs.111.P54

BSPED2025 Poster Presentations Miscellaneous/Other 1 (9 abstracts)

To induce or not to induce – that is the question. delayed puberty in a male with anorexia and ARFID – a case report and literature review

Catriona McKay ¹ , Noina Abid ¹ , Linda Agnew ² & Katherine Murtagh ¹

Author affiliations

¹Royal Belfast Hospital for Sick Children, Belfast, United Kingdom; ²Belfast Health and Social Care Trust, Belfast, United Kingdom

A 14 year and 11 month old male, with anorexia nervosa, ARFID and a background of autism, rectal prolapse and bilateral scrotal fixation, presented to endocrine clinic with delayed puberty. His auxology, staging and bloods are shown (Table1&2). His investigations demonstrate he was clinically and biochemically pre-pubertal with delayed bone age. Due to an absence of evidence for pubertal induction with testosterone in anorexic males, priority focused on weight restoration. He was admitted for medical stabilisation prior to transfer to a mental health unit. He has spent over 6 months there and approaches weight restoration. There are no physical signs of puberty. It is hoped that if he maintains his weight these will ensue. This case is felt to be unusual - it is absence rather than arrest of puberty due to enduring anorexia and ARFID. ARFID is increasingly prevalent and is relevant to endocrinologists due to its effects on growth and puberty. Consideration was given to evidence for the use of testosterone in this cohort, which is limited, this has been identified as an area for further research.

Table 1 Auxology & pubertal staging
Date and location	Age (Years and months)	Height (Centimetres)	Weight (Kilograms)	BMI (kilograms per metres squared)	Weight for Height (% of ideal BMI)	Pubertal staging
First medical admission due to low weight 03/07/20	10y7m	144	26.8	12.9	76.3	Not done
Endocrine clinic 26/11/24	14y11m	147	27.3	12.6	65.3	G1P1A1 TV< 3mls
Medical admission 13/01/25	15y1m	147	26.7	12.4	64.2	G1P1A1 TV< 3mls
Discharge to IP MH facility 18/02/25	15y2m	147	29.8	13.8	71.5	G1P1A1 TV< 3mls
Latest measurements 07/07/25	15y7m	150	42.4	18.8	94.9	Staging pending Nil changes reported by patient/ staff

Table 2 Laboratory and imaging results
Date	Test (units)	Reference range	Result
26/11/24	IGF-1 (nmol/l)	15.7 - 65.6	2.7
01/05/25			20.7
26/11/24	LH (IU/l)	1.7 - 8.6	<0.3
01/05/25			1.7
26/11/24	FSH (IU/l)	1.5 - 12.4	<0.3
01/05/25			3.6
26/11/24	Testosterone (nmol/l)	Tanner stage 2 <15	0.4
01/05/25			<0.2
26/11/24	GH (ng/ml)	N/a	3.2
26/11/24	Greulich & Pyle Bone Age	Within two standard deviations of chronological age considered normal.	12.4years -2.22SD <mean for age