Pathophysiological Interactions between Bronchial Asthma, Connective Tissue Dysplasia, and Pubertal Development: A Narrative Review
Abstract
Pubertal development is a complex neuroendocrine process regulated by activation of the hypothalamic–pituitary–gonadal(HPG) axis and influenced by genetic, inflammatory, metabolic, and nutritional factors. Bronchial asthma (BA), one of themost prevalent chronic inflammatory diseases in adolescence, has been associated with alterations in growth velocity andpubertal timing, particularly in individuals with moderate-to-severe or poorly controlled disease. However, variability inpubertal outcomes among affected adolescents suggests the presence of additional biological modifiers.Undifferentiated connective tissue dysplasia (UCTD) is a genetically determined condition characterized by abnormalitiesof collagen synthesis and extracellular matrix organization, resulting in multisystem involvement. Its high prevalenceamong adolescents with BA indicates a potential role as a structural and biological modifier of endocrine development.Current evidence suggests that the coexistence of BA and UCTD may amplify inflammatory burden and hypoxic stress.It may also contribute to extracellular matrix instability and micronutrient deficiencies, including vitamin D, zinc, andmagnesium. Together, these interacting mechanisms may disrupt hormonal regulation of the HPG axis and contribute topubertal delay or disharmonious pubertal development.Recognition of this combined pathology underscores the importance of multidisciplinary monitoring and early identificationof endocrine vulnerability in order to improve long-term reproductive outcomes.