Delayed puberty

Defined as the lack of any pubertal signs by the age of 13 years in girls and 14 years in boys. More common in boys.

May be functional (constitutional delay, underlying chronic disease, malnutrition, excessive exercise) or organic, due to either a lack of serum gonadotrophin production or action (hypogonadotrophic hypogonadism), or gonadal insufficiency with elevated gonadotrophins (hypergonadotrophic hypogonadism).

Most patients seek medical assistance because of slow growth rather than slow pubertal development.

Careful assessment of height and pubertal stage is crucial for evaluation of the underlying cause.

The distinction between organic gonadotrophin deficiency and constitutional delay of puberty is not easy and is often resolved only with time.

Patients with constitutional delay are typically observed. Sex-steroid treatment is reserved for those with psychosocial maladaptation, and consists of a short course of sex steroids to induce puberty.

Patients with an organic cause for delay are given sex-steroid therapy to induce puberty and are most likely to require lifelong hormone replacement therapy after puberty is complete.

Puberty is an interval characterised by the acquisition of the secondary sexual characteristics, accelerated linear growth, increase in the secretion of sex hormones, maturation of gonads (testes in boys; ovaries in girls), and the potential for reproduction. It is typically complete within 2 to 5 years. Delayed puberty is defined as the lack of any pubertal signs by the age of 13 years in girls and 14 years in boys.