Document 7 (2)

normal male,external genitalia

LH/FSH

increased

LH/FSH

Iow basal/after GnRH

Yes

Anorchidism/ cryptorchism	No	Testes present
			Yes
Primary		1	^r
testicular	Yes
insufficiency due	◄-	General illnesses
to generał
illness			No

Primary testicular nsufficiency after exposure to toxins

Yes

Orchiditis, trauma, radiotherapy, exposure to toxins

Yes

Normal		No	Kallmanns-
olfactory sense			syndrome
1	Yes
			Secondary
General illnesses,		Yes	hypogonadism
underweight		-►	with generał
			illness, •
			anorexia
1	No ^r
Clinical
signs of		Yes	Cushing s
hyper-		-►	disease

Autoimmune

polyglanduiar

insufficiency

No

Yes

No

	No ^r
Autoimmune diseases
	No
Małe karyotype 46,XY
'	Yes ^r

No

Further

endocrine

deficits

Yes

No

Familial factor with delayed pu berty, spontaneous onset of puberty after therapy with testosterone

45,X0/46,XY and variants

Encephalitis, meningitis, trauma, Radiotherapy, cranial pressure, detection of tumor on CT/MRI

No

Yes

Clinical signs ofTurners syndrome

'	'	Yes

Klinefelters

syndrome

Noonan

syndrome

Gonadal

dysgenesis

CNS lesion or CNS tumor

Idiopathic hypogonado-tropic hypo-gonadism

Constitutional

delayed

development

Figurę 2.4: Explanation of delayed puberty in a boy.