Definition

Girls enter puberty between the ages of 7-13. 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
  • This is the most common cause of delayed puberty in boys and girls
• Chronic illness
• Malnutrition or significant weight loss, such as with anorexia nervosa
• Hypogonadism—not enough male or female sex hormones
  • Hypogonadotropic, such as Kallmann syndrome—the brain can't make the hormones that stimulate male or female sex hormones
  • Hypergonadotropic—the male testis or female ovary can't make sex hormones
• Other endocrine diseases, such as hypothyroidism or Cushing disease
• Chromosomal abnormalities:
  • Turner syndrome (girls)
  • Klinefelter syndrome (boys)
  • Prader-Willi syndrome (boys and girls)
  • Noonan syndrome (boys and girls)
• Hypopituitarism caused by infection, trauma, and central nervous system lesions—destroys the ability to make hormones that stimulate male or female sex hormones

Risk Factors

Factors that may increase the chance of delayed puberty include:

• Family history
• Underlying disease:
  • Type 1 diabetes
  • Inflammatory bowel disease
  • Kidney disease
  • Cystic fibrosis
  • Anemia
  • Chronic infections
  • Anorexia nervosa
  • Malnutrition
  • Cancer
  • Autoimmune disease
• Other risk factors:
  • Radiation therapy
  • Chemotherapy
  • Athletes undergoing vigorous training

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Symptoms

One common symptom for both boys and girls is being short for their age. Other symptoms by gender include:

• Symptoms in boys:
  • Lack of testicular enlargement by age 14
  • Sex organs that don’t completely develop within 5 years after they started to develop
• Symptoms in girls:
  • Lack of breast development by age 13
  • Lack of menstruation 2 ½ years or more after initial breast development

Diagnosis

You will be asked about your child’s symptoms and medical history. A physical exam will be done. Your child's milestones and growth record will be reviewed. An x-ray of the left wrist bones will be taken to assess bone age. This will help to assess if bone development is normal for your child’s current level of pubertal development.

Your child's hormone levels will be tested. This can be done with blood tests.

Images may be taken of your child's bodily structures if the cause needs to be further identified. This can be done with:

• MRI scan
• Pelvic ultrasound (female)

Treatment

No treatment is usually needed 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:

Prevention

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