Abstract：
OBJECTIVE: To explore delayed puberty in cerebral palsy (CP) and to test the acceptability of an interventional puberty induction algorithm.
METHODS: A two phase cohort study in children and adolescents diagnosed with CP who have delayed puberty. Phase 1: Retrospective review of clinical records and interviews with patients who have been treated with sex-steroids and Phase 2: Prospective interventional trial of pubertal induction with a proposed algorithm of transdermal testosterone (males) or oestrogen (females). Phase 1 examined experiences with sex-steroid treatment. Phase 2 collected data on height adjusted bone mineral density (BMAD), fractures, adverse effects, mobility and quality of life over two years during the induction.
RESULTS: Phase 1, treatment was well tolerated in 11/20 treated with sex-steroids; phase 2, using the proposed induction algorithm, 7/10 treated reached Tanner stage 3 by nine months. One participant reached Tanner stage 5 in 24 months. Mean change in BMAD Z-scores was +0.27 % (SD 0.002) in those who could be scanned by dual-energy X-ray absorptiometry (DXA).
CONCLUSIONS: Delayed puberty may be diagnosed late. Treatment was beneficial and well tolerated, suggesting all patients with severe pubertal delay or arrest should be considered for sex hormone supplementation.
METHODS: A two phase cohort study in children and adolescents diagnosed with CP who have delayed puberty. Phase 1: Retrospective review of clinical records and interviews with patients who have been treated with sex-steroids and Phase 2: Prospective interventional trial of pubertal induction with a proposed algorithm of transdermal testosterone (males) or oestrogen (females). Phase 1 examined experiences with sex-steroid treatment. Phase 2 collected data on height adjusted bone mineral density (BMAD), fractures, adverse effects, mobility and quality of life over two years during the induction.
RESULTS: Phase 1, treatment was well tolerated in 11/20 treated with sex-steroids; phase 2, using the proposed induction algorithm, 7/10 treated reached Tanner stage 3 by nine months. One participant reached Tanner stage 5 in 24 months. Mean change in BMAD Z-scores was +0.27 % (SD 0.002) in those who could be scanned by dual-energy X-ray absorptiometry (DXA).
CONCLUSIONS: Delayed puberty may be diagnosed late. Treatment was beneficial and well tolerated, suggesting all patients with severe pubertal delay or arrest should be considered for sex hormone supplementation.
摘要：
目的：探讨脑瘫（CP）的青春期延迟，并测试介入性青春期诱导算法的可接受性。
方法：一项针对青春期延迟诊断为CP的儿童和青少年的两阶段队列研究。第1阶段：回顾性回顾临床记录和对接受过性类固醇治疗的患者的访谈，第2阶段：采用建议的经皮睾酮（男性）或雌激素（女性）算法进行青春期诱导的前瞻性介入试验。第一阶段检查了性类固醇治疗的经验。第二阶段收集了身高调整后骨密度(BMAD)的数据，骨折,不利影响，活动和生活质量超过两年的诱导。
结果：第1阶段，用性类固醇治疗的11/20治疗耐受性良好；第2阶段，使用拟议的诱导算法，7/10治疗到9个月时达到Tanner阶段3。一名参与者在24个月内达到Tanner阶段5。在可以通过双能X射线吸收法（DXA）扫描的人中，BMADZ评分的平均变化为0.27％（SD0.002）。
结论：青春期延迟可诊断为晚期。治疗是有益的，耐受性良好，提示所有严重青春期延迟或停滞的患者应考虑补充性激素.
方法：一项针对青春期延迟诊断为CP的儿童和青少年的两阶段队列研究。第1阶段：回顾性回顾临床记录和对接受过性类固醇治疗的患者的访谈，第2阶段：采用建议的经皮睾酮（男性）或雌激素（女性）算法进行青春期诱导的前瞻性介入试验。第一阶段检查了性类固醇治疗的经验。第二阶段收集了身高调整后骨密度(BMAD)的数据，骨折,不利影响，活动和生活质量超过两年的诱导。
结果：第1阶段，用性类固醇治疗的11/20治疗耐受性良好；第2阶段，使用拟议的诱导算法，7/10治疗到9个月时达到Tanner阶段3。一名参与者在24个月内达到Tanner阶段5。在可以通过双能X射线吸收法（DXA）扫描的人中，BMADZ评分的平均变化为0.27％（SD0.002）。
结论：青春期延迟可诊断为晚期。治疗是有益的，耐受性良好，提示所有严重青春期延迟或停滞的患者应考虑补充性激素.
