II. Definition

  1. Delayed Adolescence in Phenotypic Male or Female
  2. Girls:
    1. Delayed Breast development
      1. No Breast development by age 14 years
      2. No Breast development 5 years after Menarche
    2. No Menses by age 16 years (Primary Amenorrhea)
  3. Boys:
    1. Testicular length under 2.5 cm by age 14 years
    2. Genital growth not complete five years from start

IV. Labs (See Evaluation below)

  1. Follicle Stimulating Hormone (FSH)
  2. Luteinizing hormone (LH)
  3. Estradiol Level (in girls)
  4. Testosterone Level (in boys)
  5. Consider GnRH Stimulation Test (Step 2a below)
  6. Consider Chromosome Analysis (Step 2b below)

V. Radiology (See Evaluation below)

  1. Left wrist radiograph for Bone Age
  2. Consider Head MRI (step 2a below)

VI. Evaluation Step 1: Initial Evaluation

  1. Clinical history and physical
  2. Evaluate Pubertal Milestones (See Tanner Staging)
  3. Evaluate growth chart
  4. Obtain Left Wrist XRay for Bone Age

VII. Evaluation Step 2a: Unremarkable Evaluation in Step 1

  1. Findings
    1. Unremarkable exam except Delayed Puberty
    2. Patient has not yet experienced growth spurt
    3. Bone Age less than Chronological age
  2. Differential Diagnosis
    1. Constitutional delay
    2. See Hypogonadotropic Causes of Delayed Puberty
    3. Primary gonadal failure
    4. Serious athletic training
  3. Further evaluation
    1. Observation
    2. Laboratory testing as above
    3. Radiology evaluation as above
  4. Management
    1. Counseling and reassurance
    2. Consider sex Hormone Replacement for some patients

VIII. Evaluation Step 2b: Suspect Chromosomal Abnormality

  1. Findings
    1. Abnormal exam suggests chromosomal abnormality
    2. Bone Age may be less than Chronological age
  2. Diagnosis
    1. Girls: Turner's Syndrome
    2. Boys: Klinefelter's Syndrome
    3. Noonan's Syndrome
  3. Further evaluation
    1. Chromosome analysis
  4. Management
    1. Counseling
    2. Sex Hormone Replacement
    3. Oophorectomy in Turner's Syndrome (malignancy risk)

IX. Evaluation Step 2c: Suspect Chronic Disease in Step 1

  1. Findings suggestive of chronic disease
    1. Overt chronic illness signs or symptoms
    2. Short Stature
    3. Slow growth rate
    4. Bone Age less than Chronological age
  2. Differential Diagnosis
    1. Anorexia Nervosa
    2. Malnutrition
    3. Kallmann's Syndrome
      1. Hypopituitarism
      2. Anosmia or Hyposmia
      3. Hypogonadotropic Hypogonadism
    4. Iatrogenic
    5. Hypopituitarism
      1. Findings
        1. Growth failure
        2. Hypothyroidism
        3. Adrenal Insufficiency
        4. Diabetes Insipidus
        5. Delayed Puberty
      2. Causes
        1. Intracranial lesion (esp. involving pituitary)
        2. Infection of Pituitary Gland (e.g. Tuberculosis)
        3. Head Injury
    6. Chronic Systemic Illness
      1. Malignancy
      2. Chronic infection
      3. Chronic metabolic disease
  3. Further evaluation
    1. Work-up suspected underlying chronic disease

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Ontology: Delayed Puberty (C0034012)

Definition (NCI) Unusually late sexual maturity.
Definition (NCI_CTCAE) A disorder characterized by unusually late sexual maturity.
Definition (MSH) The lack of development of SEXUAL MATURATION in boys and girls at a chronological age that is 2.5 standard deviations above the mean age at onset of PUBERTY in a population. Delayed puberty can be classified by defects in the hypothalamic LHRH pulse generator, the PITUITARY GLAND, or the GONADS. These patients will undergo spontaneous but delayed puberty whereas patients with SEXUAL INFANTILISM will not.
Concepts Pathologic Function (T046)
MSH D011628
ICD10 E30.0
SnomedCT 267487003, 154715005, 123526007, 400003000, 39760001
English Puberty, Delayed, delayed puberty (diagnosis), delayed puberty, Delayed Puberty, Puberty, Delayed [Disease/Finding], puberty delayed, Delayed;puberty, delay puberty, Delayed pubertal development, Delayed puberty (& [NOS]), Puberty - delayed, Delayed puberty (& [NOS]) (disorder), Delayed puberty NOS, Sexual development retarded, Delayed puberty, Delayed sexual development, Delay in sexual development AND/OR puberty (disorder), Delay in sexual development AND/OR puberty, Delayed puberty (disorder), delayed; development, sexual, delayed; puberty, development; delayed, sexual, puberty; delayed, puberty; delay, sexual; development delayed, Delay in sexual development AND/OR puberty (finding)
Italian Pubertà ritardata, Ritardo puberale
Japanese シシュンキチハツショウ, 思春期遅発症, 性発育不全, 性発育遅延, 性的晩熟, 性的遅熟, 晩発思春期, 遅発思春期, 遅発症-思春期
Czech puberta opožděná, Opožděná puberta
Finnish Viivästynyt murrosikä
German Verzoegerte Pubertaet [Pubertas tarda], verzoegerte Pubertaet, Pubertas tarda, Pubertät, verspätete
Korean 사춘기 지연
Swedish Pubertet, fördröjd
Hungarian Késői pubertas
Polish Dojrzewanie płciowe opóźnione, Pokwitanie opóźnione, Opóźnione dojrzewanie płciowe
Norwegian Pubertet, forsinket, Forsinket kjønnsutvikling, Pubertas tarda, Forsinket pubertet
Dutch ontwikkeling; vertraagd, seksueel, puberteit; vertraagd, puberteit; vertraging, seksueel; ontwikkeling vertraagd, vertraagd; ontwikkeling, seksueel, vertraagd; puberteit, vertraagde puberteit, Puberteit (ontwikkelingstoestand); vertraagd, Vertraagde puberteit
Spanish pubertad tardía (hallazgo), pubertad tardía (trastorno), pubertad tardía, retraso del desarrollo sexual Y/O puberal (trastorno), retraso del desarrollo sexual Y/O puberal, Pubertad retardada, Pubertad Tardía
Portuguese Puberdade atrasada, Puberdade Tardia
French Puberté tardive, Retard pubertaire, Puberté retardée, Retard de la puberté