Approach to delayed puberty

Definition

• Absence of pubertal development in 
• girls > 14 years 
• boys > 15 years

Causes

• Constitutional delay (commonest, usually familial)
• Chronic illness (coeliac etc)
• Poor nutrition and exercise
• anorexia nervosa 
• Turner syndrome and gonadal failure

Investigations

• FBE and ESR
• Kidney function 
• Thyroid function tests
• chromosomal analysis (usually in girls to exclude turner's syndrome 
• serum FSH, LH, Prolactin, testosterone (exclude kallman syndrome) 
• x-ray of the wrist to determine bone age 
• pelvic ultrasound in girls 

Management 

• Refer to endocrinologist 

References:

1. http://www.apeg.org.au/Portals/0/Resources/Hormones_and_Me_6_Delayed_Puberty.pdf

2. John Murtagh