Pubertal Disorders in Children Delayed Puberty and Precocious Puberty Pediatric Guide — Paediatrics
Paediatrics

Pubertal Disorders in Children Delayed Puberty and Precocious Puberty Pediatric Guide

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Delayed Puberty

Definition

No puberty by:

Girls: 13 years (no breast development)

Boys: 14 years (no testicular enlargement)

Causes

Constitutional delay (most common)

Hypogonadotropic hypogonadism (↓ LH/FSH)

Hypergonadotropic hypogonadism (gonadal failure)

Clinical Clues

Short stature

Delayed bone age

Lack of secondary sexual characters

Investigations

LH, FSH, Testosterone/Estrogen

Bone age X-ray

MRI brain (if central cause suspected)

Treatment

Reassurance (constitutional)

Hormone therapy:

Testosterone (boys)

Estrogen (girls)

🔹 Precocious Puberty

Definition

Onset before:

Girls: 8 years

Boys: 9 years

Types

Central (GnRH dependent) → most common

Peripheral (GnRH independent)

Causes

Central: Idiopathic, CNS tumors

Peripheral: CAH, tumors, exogenous hormones

Clinical Features

Early secondary sexual characters

Advanced bone age

Rapid growth → early epiphyseal closure

Investigations

LH/FSH levels

GnRH stimulation test

Bone age

MRI brain

Treatment

Central → GnRH analogs

Peripheral → Treat cause

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Frequently Asked Questions

Delayed puberty is defined as absence of secondary sexual characteristics beyond the normal age range, typically after 13 years in girls and 14 years in boys.
Precocious puberty is the early onset of puberty before 8 years in girls and 9 years in boys due to early activation of hormonal pathways.
Constitutional delay of growth and puberty is the most common cause.
It is GnRH-dependent early puberty caused by premature activation of the hypothalamic-pituitary-gonadal axis.
It is GnRH-independent puberty caused by excess sex hormones from adrenal or gonadal sources.
Diagnosis involves hormone levels (LH, FSH), bone age assessment, and imaging if needed.
Bone age helps determine growth potential and differentiate between constitutional delay and pathological causes.
Central precocious puberty is treated with GnRH analogs, while peripheral causes require treatment of the underlying condition.
Short adult height, psychological issues, and early epiphyseal closure.
Evaluation is needed if puberty has not started by 13 years in girls or 14 years in boys.
Related Topics
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