Chapter-090a Delayed Puberty

BOOK TITLE: ESI Manual of Clinical Endocrinology

1. Varthakavi Premlata K
2. Joshi Ameya S
3. Bhagwat Nikhil M
Publishing Year
Author Affiliations
1. TN Medical College, Mumbai, Maharashtra, India, TNM College and BYL Nair Charitable Hospital, Dr AL Nair road Mumbai Central, Mumbai, Maharashtra, India, TNM College and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
2. Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India, Bhaktivedanta Hospital and Research Institute, Thane, Maharashtra, India
3. TNM College and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
Chapter keywords
Delayed puberty, Kallmann’s syndrome, Klinefelter’s syndrome, Turner’s syndrome, Hyperprolactinemia, hypogonadism


Delayed puberty is that when pubertal changes do not start at a chronologic age 2 standard deviations above the mean age of pubertal development for a given population. Constitutional delay in growth and puberty (CDGP) is the common reason for delayed puberty in boys than in girls. Hypogonadotropic hypogonadism explains congenital hypogonadotropic hypogonadism, Kallmann’s syndrome and idiopathic hypopituitarism. Hyperprolactinemia may lead to functional gonadotropin deficiency and children can present with arrested puberty. Klinefelter’s syndrome is the commonest cause of hypogonadism in males and it causes increased risk for testicular and yolk sac tumors and malignancies such as leukemias and lymphomas. Girls with Turner’s syndrome have short stature, sexual infantilism, or pubertal delay. CDGP is the single most common cause of delayed puberty in both sexes; it can be diagnosed physical examinations such as examination of the inguinal area for masses, visualization of the perineum to determine clitoral size in girls and scrotal rugosities, evidence of DSD etc. in boys. In addition, low gonadotropins, elevated gonadotropins and management of delayed puberty are also discussed.

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