الفهرس 
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Abstract
Introduction: Puberty is the time of starting reproductive organs functions while adolescence is defined as a period extending from puberty to full maturity. Down syndrome (DS) is a trisomy 21 chromosomal defect which disturbs motor, psychological and sexual development accompanied with multiple endocrinopathies. Although puberty takes place at a normal age of onset or somewhat earlier than in normal people, there is diminished pubertal growth rate within DS individuals. In Down syndrome, serum anti Müllerian hormone level was below normal, reflecting Sertoli cells dysfunction. Follicle stimulating hormone level was above normal levels in Down syndrome individuals. Serum testosterone level was normal, but luteinizing hormone level was above normal. This reflects minimal degree of Leydig cells dysfunction. The main issue is the necessity of the support and sex education for adolescents with Down syndrome, for prevention of sexual abuse as well as psychological treatment of adolescents. Aim of the work: To study pubertal development in adolescent boys with Down syndrome and compare these changes to normal boys of comparable age group. Research Plan: The study included 30 adolescent males with Down syndrome, aged between 12 and 21 years and 20 normal adolescent boys within the same age range as control group. Each included subjects in the study were submitted to the following: Thorough history taking and thorough clinical examination including height, weight, B.M.I, assessment of secondary sex characters, penile length, pubic hair distribution, testicular volume, Tanner staging and assessment of serum hormonal levels for: FSH, LH, total testosterone, prolactin and anti müllerian hormone. Results: Down syndrome is associated with pubertal abnormalities. It may have delayed onset or it may arrest at one of Tanner stages, puberty in Down syndrome has impaired growth spurt with increased incidence of cryptorchidism, smaller testicular volume, smaller penile length and diminished secondary sex characters with abnormal sex hormone profile in the form of elevated FSH and LH and prolactin with low AMH and testosterone level. Conclusion: Pubertal abnormalities are common aspect for DS developmental delay due to primary partial hypogonadism and the risk of abnormal puberty is increased with associating disorders like hypothyroidism and the risk is increased in patients with multiple associating disorders. Recommendations: Great efforts are still needed to give Down syndrome adolescents the medical and psychological support which they need, especially regarding sexual aspect. They need pubertal assessment to detect medical causes of pubertal delay or its arrest at any stage, with trial to treat these causes. Sex education is essential to protect Down syndrome adolescents from hazards of sexual abuse.