Delayed puberty

Delayed puberty is defined as the lack of pubertal signs at an age that is 2 to 2.5 standard deviations later than the population mean, typically by the age of 13 years in girls and 14 years in boys. It is more common in boys.

Delayed puberty 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).

Many 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 (self-limited) delay of puberty is not easy and is often resolved only with the passage of time.

Patients with constitutional delay are typically monitored clinically. Sex-steroid treatment is reserved for those with a more marked delay or 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 (or gonadotrophins in hypogonadotrophic hypogonadism) 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 specific pubertal signs, which is defined by breast budding in girls and a testicular volume of 4 mL or more in boys, at an age that is 2 to 2.5 standard deviations later than the population mean, typically by the age of 13 years in girls and 14 years in boys.[1]Palmert MR, Dunkel L. Clinical practice. Delayed puberty. N Engl J Med. 2012 Feb 2;366(5):443-53. http://www.ncbi.nlm.nih.gov/pubmed/22296078?tool=bestpractice.com