Delayed puberty is defined as the failure of secondary sexual characteristics to appear by the age of 14 years.
Delayed puberty is classified based on the causes into two:
- central (hypogonadotrophic hypogonadism)
- gonadal (hypergonadotrophic hypogonadism).
Central causes of delayed puberty includes conditions that prevent hypothalamic GnRH production/release, such as:
- Excessive exercise
- Anorexia nervosa
- Kallman’s syndrome
- Pituitary tumour
- Chronic illness (sickle cell disease, diabetes mellitus, etc).
Gonadal causes include:
- Turner’s syndrome
- XX (pure) gonadal dysgenesis
- Premature ovarian failure, caused by autoimmune diseases, chemotherapy/radiotherapy exposure and idiopathic causes.
Investigations for delayed puberty
- Assay of serum LH and FSH
- Radiological: Pelvic ultrasound, brain CT scan, skull X-ray and MRI
Treatment of delayed puberty
- Constitutional delayed puberty require no drug treatment; only counselling and follow-up.
- Central causes are managed with pulsatile gonadotrophin administration or low dose oestradiol 1-2ug per day for 3-6 months.
- Gonadal cause are treated with oestrogen (and progesterone) replacement.