Case Presentation: Delayed Puberty

Abstract

Delayed puberty is extremely common condition in both boys and girls. Delayed puberty is defined clinically as the absence of the first signs of physical and hormonal signs of pubertal development beyond the normal range for the population. In the developed world, this means the absence of breast development by age 12 years in girls, or absence of testicular enlargement by age 14 years in boys. However, there are racial and ethnic variations in the timing of puberty, such as earlier onset of puberty in African American girls compared with Caucasian counterparts (Table 1). Puberty may be delayed for several years and still occurs normally, in which case it is considered constitutional delay, a variation of healthy physical development. Delay of puberty may also occur due to undernutrition, chronic illness or systemic disease, or to defects of the reproductive system (hypogonadism) or the body’s responsiveness to sex hormones. Any girl of 13 or boy of 14 years of age without signs of pubertal development falls more than 2.5 SD above the mean and is considered to have delayed puberty.