Definition

Girls enter puberty between the ages of 8-14. Boys enter this stage between the ages of 9-14. When this stage is late, it is called delayed sexual development.

Causes

This condition can be caused by:

    
  • Constitutional delay—some children simply take longer than their peers; they will catch up at some point
  • Chromosomal abnormalities:     
  • Turner syndrome (girls)
  • Klinefelter syndrome (boys)
  • Prader-Willi syndrome (boys and girls)
  • Noonan syndrome (boys and girls)
  • Hypogonadism
  • Kallman’s syndrome
  • Hypopituitarism caused by infection, trauma , and central nervous system lesions
  • Complications From Cystic Fibrosis

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    Risk Factors

    Factors that may increase the chance of delayed puberty include:

        
  • Family history
  • Underlying disease:     
  • Diabetes mellitus
  • Inflammatory bowel disease
  • Kidney disease
  • Cystic fibrosis
  • Anemia
  • Chronic infections
  • Anorexia nervosa
  • Malnutrition
  • Cancer
  • Autoimmune disease
  • Other factors:     
  • Radiation therapy
  • Chemotherapy
  • Athletes undergoing vigorous training
  • Symptoms

    One common symptom for both boys and girls is shortness in height. Other symptoms by sex include:

        
  • Symptoms in boys:     
  • Lack of testicular enlargement by age 14
  • Lack of pubertal maturation by age 14
  • Sex organs that don’t completely develop within five years after they started to develop
  • Symptoms in girls:     
  • Lack of breast development by age 13
  • No breast tissue or pubic hair by the age of 14
  • Lack of menstruation for five years or more after initial breast development
  • Failure to menstruate by age 15-16
  • Diagnosis

    The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Your doctor will review your child's milestones and growth record. An x-ray of the left wrist bone may be taken. This will help to assess if bone development is normal for your child’s age.

    Your child's bodily fluids and tissues may be tested. This can be done with blood tests.

    Images may be taken of your child's bodily structures. This can be done with:

        
  • MRI scan
  • Pelvic ultrasound (female)
  • Skull x-ray
  • Treatment

    There is often no treatment for those who are healthy and just starting later than their peers. They will continue to be monitored.

    Other treatment depends on the cause. For those who have a chronic underlying disease, treatment is aimed at the specific condition. After the condition is treated, puberty often begins on its own.

    For others treatments may include:

    Sex Hormone Replacement

    Sex hormones will help begin sexual development. They may be given to those with chromosomal abnormalities. This can include Turner or Klinefelter syndrome. Hormones may also be given to teens who are severely delayed or overly stressed by their lack of development.

    Other medications may be added to sex hormone replacement. They may help increase height in boys with constitutional delay of puberty.

    Psychological Support

    Counseling may be suggested for adolescents who are struggling with the delay. This may help the child cope with social pressures.

    Ongoing Monitoring

    The doctor will continue to monitor your child’s height, weight, and sexual development. This will help determine if any treatment has been effective.

    Prevention

    Most causes of delayed sexual development cannot be prevented. To help reduce the chance, make sure your child is kept as healthy as possible. This includes making sure your child is eating well and getting nutrients. Make sure any underlying illness is treated.