Delayed puberty (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Jinhui Wu, MD

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What is delayed puberty?

Puberty is the time when your body grows from a child's to an adult's. During piberty, children's external genitalias 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.

How do I know if I have delayed puberty and what are the symptoms of delayed puberty?

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.

Who is at 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

How to know you have delayed puberty?

• Hormone level tests: Blood levels of gonadotropins， such as follicle-stimulating hormone (FSH), luteinizing hormone (LH) and gonadal hormone, such as estradiol (E2) and testesterone, are the most valuable tests for diagnosis.
• Bone age x-ray test: Comparing to normal children, bone age test in patients with delayed puberty demonstrates a delayed physical maturation.
• Cranial computed tomography (CT) or magnetic resonance imaging (MRI): When cranial tumor is suspected, CT or MRI can help the doctor analyse the cause of the delayed puberty.
• Chromosomal analysis: For patients with gonadal dysgenesis or signs of unusual facies, chromosomal analysis is needed to detect some genetic diseases.

When to seek urgent medical care?

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

Treatment options

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 adolescent 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 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, facilitate communication between the family and medical team.

Where to find medical care for delayed puberty?

Directions to Hospitals Treating delayed puberty

Prevention of delayed puberty

• 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)?

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.

Copyleft Sources

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

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