Delayed Puberty

Delayed puberty is defined as the lack of any pubertal signs by the age of 13 years in girls and 14 years in boys.  It affects approximately 2% of adolescents and is more common in boys.  Most patients seek medical assistance because of slow growth rather than slow pubertal development. 

The causes of delayed puberty can be divided into central and peripheral.

• Central causes – there is nothing wrong with the testes or ovaries but there is no signal from the pituitary to stimulate them to produce oestrogen and testosterone

Functional impairment (i.e. intact hypothalamic pituitary axis)

• Most patients presenting with pubertal delay have a temporary functional delay that resolves with time. 
  • The most common cause is constitutional delay which tends to run in families. 
  • Functional delay may also occur due to chronic illness, excessive physical exercise, malnutrition and eating disorders and prolonged stress.

Permanent impairment / hypogonadotropic hypogonadism (i.e. impaired hypothalamic pituitary axis)

• Idiopathic, developmental abnormalities of HP axis, trauma, tumours etc.

• Peripheral causes – the pituitary is producing LH and FSH but there is an impairment of  the testes or ovaries which results in them not being  able to produce oestrogen or testosterone

Hypergonadotrophic hypogonadism

• Congenital disorders e.g. cryptorchidism
  • Chromosomal disorders e.g. Klinefelters, Turners
  • Acquired e.g. testicular torsion, chemotherapy, infections, testicular or ovarian surgery