Delayed puberty (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jinhui Wu, M.D., Eiman Ghaffarpasand, M.D. [2]

Overview[edit | edit source]

Puberty is the time when your body grows from a child's to an adult's. During puberty, children's external genitalia begin development and show secondary sex characteristics. The normal age of puberty is between 7 and 13 for girls and 9 and 15 for boys. Some adolescents do not start their sexual development at the usual age. They do not show any signs of body changes. This is called delayed puberty. The delay in some cases represents a normal variation, but other causes are some kind of diseases, such as diabetes, inflammatory bowel disease, kidney disease, cystic fibrosis, mumps, anemia, and genetic diseases. Tests such as hormone level tests and bone age X-ray test, even cranial CT or MRI and chromosomal analysis may help find the causes of delayed puberty. Treatment and prognosis of delayed puberty depend on the cause.

What are the Symptoms of Delayed Puberty?[edit | edit source]

Delayed puberty is more common among boys. Usual symptoms in boys and girls are:

• Boys:
  • Lack of testicular enlargement by age 14
  • Lack of pubic hair by age 15
  • Delayed completion of genital enlargement at least 5 years
  • Psychologic stress
• Girls:
  • Absence of breast development by age 13
  • A time lapse of more than 5 years from the beginning of breast growth to the first menstrual period, or failure to menstruate by age 16

What Causes Delayed Puberty?[edit | edit source]

• The main cause of delayed puberty is hormonal disturbances.
• Other causes of delayed puberty are as following:
  • Without any reason (idiopathic)
  • Brain tumor
  • Chromosomal disorders
  • Genetic diseases
  • Trauma
  • Specific environmental stresses

Who is at Highest Risk for Delayed Puberty?[edit | edit source]

Children with the following conditions are at higher risk for delayed puberty:

• Diabetes mellitus
• Inflammatory bowel disease
• Kidney disease
• Cystic fibrosis
• Mumps
• Anemia
• Excessive exercise or dieting in girls
• A tumor that damages the pituitary gland or the hypothalamus
• Radiation therapy or chemotherapy for cancer in adolescents
• Turner's syndrome
• Klinefelter's syndrome

Diagnosis[edit | edit source]

• Physical examination of patients with delayed puberty is usually remarkable for delayed growth spurt along with small testicular size (less than 4 mL or 2.5 cm) in more than 14 years old boys and thelarche stage 0-1 in more than 13 years old girls.
• Laboratory tests that can help to diagnose delayed puberty are including sex hormones assay, genetic assay, and also chromosomal study (karyotyping)
• An X-ray may be helpful in the diagnosis of delayed puberty. Findings on an X-ray are specific to measuring bone age.
• There is limited role for CT scan to measure the bone age more precise.
• Brain MRI may be helpful in the diagnosis of delayed puberty.

When to Seek Urgent Medical Care?[edit | edit source]

• Contact your doctor if your child has signs and symptoms that seem to suggest delayed puberty.

Treatment Options[edit | edit source]

The treatment for delayed puberty depends on its cause. Different cause has different protocol.

• An adolescent who is naturally late in developing needs no treatment.

• For those adolescents who is stressed by the delayed or absent of development, doctors may give supplemental sex hormones to make the process sooner.
• For those whose delayed puberty is caused by some diseases, such as diabetes mellitus, inflammatory bowel disease, kidney disease, or cystic fibrosis, treatments of these disorders are the first important step.
• For genetic disorders, such as Turner's syndrome and Klinefelter's syndrome, replacing hormones may help sex characteristics to develop.
• For brain tumors, surgery may be needed at first.
• Psychological support: Appropriate psychosocial support for the patient is necessary. The doctors can supply accurate and complete information about the disease, provide emotional support for the teenagers, and also facilitate communication between the family and medical team.

Where to Find Medical Care for Delayed Puberty?[edit | edit source]

Directions to Hospitals Treating delayed puberty

Prevention[edit | edit source]

• Early treatment of diseases, such as inflammatory bowel disease, kidney disease, cystic fibrosis, and anemia.
• Preventing from mumps infection, you can get mumps vaccines under the doctor's direction.
• Genetic counseling for parents with family history of Turner's syndrome or Klinefelter's syndrome.
• Avoiding excessive exercise or dieting in some girls.

What to Expect (Outook/Prognosis)?[edit | edit source]

Prognosis of delayed puberty depends on the cause of the disease. Outcome of patients with delayed puberty resulting from tumors is worse than outcomes from other causes.

Possible Complications[edit | edit source]

• Osteoporosis
• Short stature
• Infertility

Copyleft Sources[edit | edit source]

http://www.merck.com/mmhe/print/sec23/ch271/ch271b.html

http://kidshealth.org/teen/sexual_health/changing_body/delayed_puberty.html

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