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 gonadotropin production or action (hypogonadotropic hypogonadism), or gonadal insufficiency with elevated gonadotropins (hypergonadotropic 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 gonadotropin 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 characterized 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.
History and exam
- family history of delayed puberty
- congenital pituitary structural abnormalities
- gene mutations
- chromosomal disorders
- syndromic diagnosis
- eating disorders
- chronic systemic illness
- intense exercise
- congenital testicular abnormalities
- acquired gonadal abnormalities
- pituitary surgery
- adrenal hypoplasia
- radiation therapy
- sickle cell disease
- iron overload (associated with transfusion)
- luteinizing hormone-releasing hormone stimulation test
- human chorionic gonadotropin stimulation test
- MRI brain
- ultrasound pelvis and abdomen
- serum ovarian autoantibodies
- assessment of olfaction
- thyroid function tests
- serum prolactin
- other pituitary hormone investigations
Ameeta Mehta, MBBS, DCH, DNBE, MSc, MRCP, MD
AM is an author of several articles cited in this topic.
Peter Hindmarsh, BSc, MD, FRCP, FRCPCH
Professor of Paediatric Endocrinology
University College London
PH is an author of several articles cited within this topic.
Dianne Deplewski, MD
Assistant Professor of Pediatrics
University of Chicago
DD declares that she has no competing interests.
Nicola Bridges, DM MRCP FRCPCH
Consultant Paediatric Endocrinologist
Chelsea and Westminster Hospital
Honorary Senior Lecturer
Imperial College School of Medicine
NB declares that she has no competing interests.
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