Puberty concerns in boys
Disclaimer
These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
|
Introduction
This guideline is suggested for use by medical practitioners when the following pubertal conditions in boys are suspected and tertiary endocrine assessment is sought:
- Precocious puberty
- Delayed puberty
- Premature adrenarche
NB: Please provide all information requested in this guideline to avoid the referral being declined and risking a delay in the provision of care for the child and family.
When to refer
Referrals for puberty in boys across the three conditions are categorised as routine or urgent. All categories require a series of clinical examination findings as well as investigations and imaging prior to referral.
Refer to the Endocrinology Department as outlined below:
1. Precocious puberty
Urgent referral
Clinical findings
- Boys < 9 years
- Testicular enlargement (>4mL or 2.5cm)
- Penile enlargement
Pre-referral work-up
- Bone age
- TSH, free T4
- LH, FSH
- Testosterone
2. Delayed puberty
Routine referral
Clinical findings
- No testicular enlargement (4mL or 2.5cm) by 14 years of age
Pre-referral work-up
- Bone age
- TSH, free T4
- LH, FSH
- Testosterone
Referral requirements
- Growth chart
- Bone age results
- Lab results
- Relevant clinical note
- Physical examination including Tanner stages.
3. Premature adrenarche
Urgent referral
Clinical findings
- Boys < 7 years with one or more of the following signs: pubic hair, axillary hair, body odour, penile enlargement, accelerated growth; but no testicular enlargement (<4 ml or <2.5 cm)
- Boys 7 – 9 years with one or more of the above signs and accelerated growth
Pre-referral work-up
- Bone age
- 17OH progesterone
- Testosterone
- DHEAS
Routine referral
Clinical findings
- Boys 7 – 8 years with one or more of the above signs, but NO accelerated growth
Pre-referral work-up
Consider:
- 17OH progesterone
- Testosterone
- DHEAS
Please refer once all assessments have been requested (minimum) and/or completed (preferred).
Referrers should also consider:
- Further medical imaging such as pelvic ultrasound or brain/pituitary MRI
- In benign premature thelarche, the nipples are not usually dark or enlarged as seen in precocious puberty.
- Pubic hair on the suprapubic area is more indicative of precocious puberty than hair on the scrotum.
Referrals may not be required for:
- Fine downy and non-pigmented short hair in the supra pubic area or scrotum (not considered secondary sexual pubic hair)
If you are unsure if a referral is required, please call PCH Switch on 6456 2222 and ask to speak to the on-call Endocrinologist.
Essential information to include in your referral
- Parents height, weight, onset of puberty
- Sibling/s height, weight, onset of puberty
- Medication use that may influence pubertal development i.e. testosterone crème
- Serial measurements of the patient in a growth chart
- Relevant clinical notes
- Physical examination findings including Tanner stages
- Bone age
- Blood tests as detailed above and results (and/or means of how they can be accessed- essential if not performed with Pathwest).
How to refer
- Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
- Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals are made via the PCH Referral Office
- Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call PCH Switch on 6456 2222 to discuss referral with the Endocrinologist.
Useful resources
| Reviewer/Team: |
Dr Aris Siafarikas, Head of Dept, Endocrinology |
Last reviewed: |
Aug 2021 |
|
|
Review date: |
Aug 2024 |
This document can be made available in alternative formats on request for a person with a disability.