ACTIVITY NUMBER:  RES004

ACTIVITY TITLE: Delayed Puberty

ACCREDITATION STATEMENT

The American Society for Reproductive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Release Date:  June 1, 2019

Reviewed 2016

Reviewed and updated 2019

Expiration Date: May 31, 2022

Under Review June 2022

Estimated Time to Complete Activity: 1.0 hour

NEEDS ASSESSMENT and IDENTIFICATION OF PRACTICE GAP

The diagnosis of true delayed puberty is often complicated by the wide variation in normal sexual development and its relative rarity. Etiologies of delayed puberty include primary hypergonadotropic and hypogonadotropic hypogonadism, as well as secondary anatomic and functional abnormalities.   Determination of whether the delay is physiologic (constitutional growth delay) or pathologic is critical in mitigating long-term consequences for these young women. Since diagnosis is often made by exclusion of other conditions, the physician’s role in taking a history and in examination is important to identify familial traits, physical characteristics, and behaviors such as extreme exercise associated with delayed pubertal onset.   In a 2008 survey of practicing reproductive care physicians, fewer than 5% could correctly identify the roles for reproductive endocrinologists in collaborative care of children affected by developmental sex disorders, which include conditions related to delayed puberty.

This educational activity is designed to address the Unit 5 Reproductive Endocrinology educational objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG) on this topic.

EDUCATIONAL OBJECTIVES
At the conclusion of the educational activity, participants should be able to:

1.      Describe the principal causes of delayed puberty.

2.      Describe the history of a patient with delayed puberty.

3.      List the components of a physical examination and interpret tests to evaluate the etiology of delayed puberty.

4.      Describe the treatment of a patient with delayed puberty.

5.      Describe the indications for referral.

6.      Counsel a patient and her family about her long-term follow-up and prognosis and the effect of her condition on reproduction.

7.      Counsel the patient and her family about the long-term prognosis of her condition.

TARGET AUDIENCE

This activity is designed to meet the educational needs of resident physicians in obstetrics and gynecology and other related specialties.

ACGME COMPETENCIES

Medical Knowledge

Patient Care

Interpersonal and Communication Skills

SUCCESSFUL COMPLETION REQUIREMENTS

Successful completion of this educational activity requires the learner to:

·        View a course overview page, containing all CME and disclosure information, including acknowledgement of commercial support and disclosure of unlabeled use, prior to the start of each module.

·        Complete a 10-question pre-exam prior to the module. Learners should note any pre-exam questions answered incorrectly for clarification during module study.  

·        Be given the option of downloading a printed syllabus containing the presentation and narrative.

·        Participate in the interactive activity: Audio narration is synchronized with PowerPoint presentation that can be advanced, stopped or reversed as desired.

·        Complete a 10-question post-exam, with feedback of correct/incorrect answers, scoring a minimum of 70% in two attempts.

·        Complete the evaluation survey.

·        Print certificate of completion.

DISCLOSURES FOR PLANNERS AND FACULTY

Ruben J.  Alvero, MD – Nothing to Disclose

Alicia Y. Armstrong, MD – Nothing to Disclose

Valerie Baker, MD – Institutional Support from IBSA

Nancy A. Bowers, BSN, RN, MPH – Nothing to Disclose

Bruce R. Carr, MD – Research support from Wyeth, Neurocrine, Boehringer Ingelheim; Consultant for Novo Nordisk

Marcelle I. Cedars, MD  – Nothing to Disclose

Elizabeth Grill, PsyD – Nothing to Disclose

Bradley S. Hurst, MD – Nothing to Disclose

Andrew R. La Barbera, PhD, HCLD  – Nothing to Disclose

Lawrence C. Layman, MD – Nothing to Disclose

Meredith Loveless, MD – Nothing to Disclose

Patricia M. McShane, MD – Consultant, World Egg Bank

Shona C. Murray, MD - Consultant, World Egg Bank

Steven T.  Nakajima, MD –Consultant, research support, speaker’s bureau for Warner Chilcott; Stockholder for IntegraMed

Genevieve Neal-Perry, MD, PhD – Nothing to Disclose

Linda R. Nelson, MD, PhD  – Nothing to Disclose

Lubna Pal, MBBS, MS – Research grant from Ferring

Staci E. Pollack, MD – Nothing to Disclose

Robert W. Rebar, MD – Nothing to Disclose

Richard H. Reindollar, MD – Nothing to Disclose

Nanette Santoro, MD  – Consultant for QuatRx

James H. Segars, MD – Nothing to Disclose

Mary D. Stephenson, MD, MSc –  Consultant for NoraTherapeutics

Kim L. Thornton, MD – Consultant for Parexel

Ellen Wilson, MD – Nothing to Disclose

Bo Yu, MD – Nothing to Disclose

It is the policy of the ASRM to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty/authors participating in this activity were required to disclose any relationships they may have with commercial entities whose products or services are used to treat patients so that participants may evaluate the objectivity of the presentations. The content and views presented in this activity are those of the faculty/authors and do not necessarily reflect those of the ASRM or CREOG. Any discussion of off-label, experimental, or investigational use of drugs or devices will also be disclosed. The disclosure statements were reviewed by the Subcommittee for Standards of Commercial Support of the CME Committee of ASRM and any perceived conflicts of interest were resolved in accordance with the policies of the ACCME.

STATEMENT OF SUPPORT

No commercial support has been provided for this activity.