Delayed Puberty

In the majority of cases, delayed puberty represents a normal variation, which may run in the family (also called constitutional delay of puberty Constitutional Delay of Puberty Hypogonadism is decreased production of testosterone, sperm, or both in males. Hypogonadism occurs when there is a problem in the testes or a problem in the pituitary gland or the hypothalamus... read more ). These adolescents have a normal growth rate and are otherwise healthy. Although the growth spurt and puberty are delayed, they eventually proceed normally.

Various disorders, such as poorly controlled diabetes mellitus Diabetes Mellitus (DM) in Children and Adolescents Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced... read more , inflammatory bowel disease Overview of Inflammatory Bowel Disease (IBD) In inflammatory bowel diseases, the intestine (bowel) becomes inflamed, often causing recurring abdominal pain and diarrhea. The two primary types of inflammatory bowel disease (IBD) are Crohn... read more , kidney disease, cystic fibrosis Cystic Fibrosis (CF) Cystic fibrosis is a hereditary disease that causes certain glands to produce abnormally thick secretions, resulting in tissue and organ damage, especially in the lungs and the digestive tract... read more , and anemia Overview of Anemia Anemia is a condition in which the number of red blood cells is low. Red blood cells contain hemoglobin, a protein that enables them to carry oxygen from the lungs and deliver it to all parts... read more , can delay or prevent sexual development. Development may be delayed or absent in adolescents receiving radiation therapy or cancer chemotherapy. Puberty may also be delayed by autoimmune disorders (such as Hashimoto thyroiditis Hashimoto Thyroiditis Hashimoto thyroiditis is chronic, autoimmune inflammation of the thyroid gland. Hashimoto thyroiditis results when antibodies in the body attacks the cells of the thyroid gland—an autoimmune... read more , Addison disease Adrenal Insufficiency In adrenal insufficiency, the adrenal glands do not produce enough adrenal hormones. Adrenal insufficiency may be caused by a disorder of the adrenal glands, a disorder of the pituitary gland... read more , and some disorders that directly affect the ovaries). A tumor that damages the pituitary gland or the hypothalamus can lower the levels of gonadotropins or stop production of the hormones altogether.

In boys, testicular disorders such as injury, for example, resulting from prior twisting of a testis (testicular torsion Testicular Torsion Testicular torsion is the twisting of a testis on its spermatic cord so that the blood supply to the testis is blocked. Testicular torsion causes sudden, severe pain and later swelling of the... read more ), or infection (such as mumps Mumps Mumps is a contagious viral infection that causes painful enlargement of the salivary glands. The infection may also affect the testes, brain, and pancreas, especially in adolescents and adults... read more ) may delay puberty. Adolescents, particularly girls, who become very thin because of excessive exercise or dieting often have delayed puberty, including an absence of menstruation (amenorrhea Absence of Menstrual Periods Having no menstrual periods is called amenorrhea. Amenorrhea is normal in the following circumstances: Before puberty During pregnancy While breastfeeding read more ).

Chromosomal abnormalities, such as Turner syndrome Turner Syndrome Turner syndrome is a sex chromosome abnormality in which girls are born with one of their two X chromosomes partially or completely missing. Turner syndrome is caused by the deletion of part... read more in girls and Klinefelter syndrome Klinefelter Syndrome Klinefelter syndrome is a sex chromosome abnormality in which boys are born with two or more X chromosomes, instead of one, and one Y (XXY). Klinefelter syndrome occurs when a boy has one extra... read more in boys, and other genetic disorders can affect the production of sex hormones. One of these genetic disorders, Kallmann syndrome Kallmann syndrome Hypogonadism is decreased production of testosterone, sperm, or both in males. Hypogonadism occurs when there is a problem in the testes or a problem in the pituitary gland or the hypothalamus... read more , affects only gonadotropin production without affecting production of other hormones.

In girls, breast development, pubic hair growth, the first menstrual period, or a combination do not occur. In boys, genital growth, pubic hair growth, or both do not occur. Short stature Growth Hormone Deficiency in Children , poor speed of growth, or both may indicate delayed puberty in either sex.

Adolescents who have delayed puberty may be noticeably shorter than their peers, can be teased or bullied, and often need help coping with and managing social concerns. Although adolescents are typically uncomfortable about being different from their peers, boys in particular are more likely to feel psychologic stress and embarrassment resulting from delayed puberty.

The initial evaluation of delayed puberty should consist of a complete history and physical examination to evaluate pubertal development, nutritional status, and growth.

Doctors often take x-rays of one or more bones to see the level of bone maturity (called a bone age x-ray).

Doctors take blood samples and do basic laboratory tests to look for signs of chronic disease, hormone level tests, and possibly genetic testing.

Doctors usually evaluate boys who have no signs of puberty by age 13 or 14 years and girls who have no signs of puberty by age 12 or 13 years or who have not menstruated by age 15 years. If these children otherwise appear healthy, they most likely have constitutional delay. The doctor may decide to re-examine these adolescents at 6-month intervals to ensure that puberty begins and progresses normally.

Girls with severely delayed puberty should be evaluated for primary amenorrhea Evaluation Having no menstrual periods is called amenorrhea. Amenorrhea is normal in the following circumstances: Before puberty During pregnancy While breastfeeding read more . This evaluation includes an ultrasound of the pelvis and other blood and genetic tests.

Magnetic resonance imaging Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more (MRI) may be done to ensure that there is no brain tumor or structural abnormality in the pituitary gland.

The treatment for delayed puberty depends on its cause. When an underlying disorder is the cause of delayed puberty, puberty usually proceeds once the disorder has been treated.

An adolescent who is naturally late in developing needs no treatment, but if the adolescent is severely stressed by delayed or absent development, some doctors may give supplemental sex hormones to begin the process sooner. This treatment is much more common among boys. Children with delayed puberty often need additional support from parents, family members, and friends to ensure they have a healthy body image and self-esteem.

If boys show no sign of puberty by age 13 or 14, they may be given a 4- to 6-month course of testosterone injections once a month. At low doses, testosterone starts puberty, causes the development of some masculine characteristics (virilization), and does not prevent adolescents from reaching their adult height potential.

In girls, low doses of estrogen may be started with pills or skin patches. This estrogen therapy may be used to induce puberty or, in some cases, such as in girls who have Turner syndrome, may be needed for long-term hormone replacement.

Genetic disorders cannot be cured, but hormone therapy may help sex characteristics develop.

Surgery may be needed to remove pituitary tumors, and these children are then at risk of hypopituitarism Hypopituitarism Hypopituitarism is an underactive pituitary gland that results in deficiency of one or more pituitary hormones. Symptoms of hypopituitarism depend on what hormone is deficient and may include... read more (a deficiency of one or more pituitary hormones).