Delayed puberty is a medical condition in which signs of puberty like sexual development and other characteristics appear later than usual. According to the population studies, there are standard criteria to diagnose this condition. The most common cause is a constitutional delay of growth and puberty (CDGP) and almost 90% of cases of delayed puberty are associated with it less common causes include chronic illnesses, excessive exercise, and even stress. About 3% of children suffer variation in normal puberty.
Diagnostic Criteria for Delayed Puberty
Delayed puberty is defined by
In boys
No testicles development by age 14. Or
Testicular volume lower than 4 ml
In girls
No breast development by age 13. Or
No periods, despite breast development by age 15
Normal Puberty process
Let’s have a look at the normal process
Hypothalamus– a small part of the brain which starts producing a hormone during the usual period of puberty which marks the start of puberty.
Pituitary – under influence of this hormones release gonadotropins
Your doctor will ask you some question related to your medical history, conduct a physical exam and medical test to find the cause of delay in puberty
Medical history: Your doctor will ask you many questions related to your symptoms, your current or past medical illnesses, family history
Physical examination: Basically, your doctor will check for the sound of the chest, heart, abdomen, and determine your pubertal staging.
There are five stages of puberty defined by your degree of breast development, body hair growth, size or testicles or penis
Since most of the teenagers suffer from CDGP they don’t require extensive investigation but before, it is recommended to exclude all the causes. So, your doctor may want additional tests such as
Blood test: it may provide some clue to the underlying cause if any by measuring
Levels of several hormones like gonadotropins, testosterone, estrogen, thyroxine, prolactin
Electrolytes balance, ferritin levels
Chromosome analysis to look for any sex chromosome related syndromes
Imagining tests
X-rays: to determine the bone age by taking an x-ray of the wrist. Delayed bone age may occur in CDGP, hypothyroidism and growth hormone deficiency
Ultrasound: Ultrasound of pelvis in females can be used to look for cysts or tumor
MRI/CT scan of the brain can be done to find out any pituitary lesion
Treatment of Delayed Puberty
It consists of treating the cause or hormone therapy or a combination of both
For CDGP – treatment is often not required for the teenagers, monitoring and reassurance is sufficient. Boys often seek for medical treatment because they are worried about their heights. So, short courses of anabolic steroids can be used to allow individuals to catch up height.
For chronic illness – if puberty is delayed due to an underlying chronic cause then treatment is required but sometimes a short course of hormone therapy may be required to initiate puberty.
Hormonal treatment – it is usually reserved for the true cases of gonadotropin hormone deficiency or some diseases of testes or ovaries causing no production of sex hormones. In these cases, increasing concentrations of testosterone or estrogen is given to induce puberty. Some patients require lifelong therapy if they have a deficiency of sex hormones still after completion of puberty.
Reference:
Managing delayed or altered puberty in boys. BMJ. 2012 Dec 3345: e7913. DOI: 10.1136/bmj. e7913.
Sex Steroid Treatment for Pubertal Induction and Replacement in the Adolescent Girl; Royal College of Obstetricians and Gynaecologists – Scientific impact paper
Disorders of pubertal development. Dtsch Arztebl Apr106(17):295-303
Delayed puberty; British Society for Paediatric Endocrinology and Diabetes