Delayed Puberty
Delayed Puberty:
Delayed puberty or delayed sexual development is defined as lack of any breast development in girls by 14 years of age or when more than five years have passed between initial growth of breast tissue and the onset of menses (menarche). Girls who develop secondary sexual characteristics but fail to achieve menarche by 16 years of age should be evaluated for primary amenorrhea. In boys, delayed sexual development is defined as no testicular enlargement by 14 years of age or the passing of five years between the initial and complete development of the genitalia.
Individuals with delayed puberty may be classified into one of three groups based on the initial clinical assessment: (1) those who appear otherwise normal; (2) those who have the stigma of a chromosomal abnormality; and (3) those who appear to have some type of chronic disease.
Laboratory testing will be determined by the initial clinical assessment and suspected cause. If your reproductive endocrinologist suspects a hormonal abnormality, determination of the serum levels of TSH, T4, FSH, LH and prolactin are usually indicated, and a GnRH stimulation test may be useful. MRI scanning of the brain and pituitary gland may be helpful if an abnormality of the hypothalamic-pituitary axis is suspected. A chromosome analysis might be considered, especially in short girls with delayed puberty.
The differential diagnosis of delayed puberty is quite long, but most children will be found to have a constitutional delay, some form of hypopituitarism, or gonadal failure associated with a sex chromosome abnormality. Your reproductive endocrinologist is trained in the evaluation and management of these disorders and will work closely with your pediatrician or family physician.
