Delayed Puberty in Girls

1. What is delayed puberty?

Failure to enter into puberty later than 14 years is called delayed puberty.

2. What are the causes of delayed puberty?

These can be divided into general causes and specific causes. Constitutional delay of growth and puberty, chronic childhood diseases and under nutrition are the general causes. The specific causes are related to under production of sex hormones.

3. What the problems related to sex hormone production?

The under production of sex hormones could be either because of problem in the pituitary gland or in the testes. If the problem lies in the pituitary gland then it is called hypogonadotrophic hypogonadism. If the problem is in the testes then it is called hypergonadotrophic hypogonadism.

4. What are the causes for the hypogonadotrophic hypogonadism?

They are:

  1. Kallaman’s syndrome: Sense of smell is also affected
  2. Tumors or radiation in the region of pituitary
  3. Genetic problem

5. Why does hypergonadotrophic hypogonadism happen?

It is because of

  1. Turner’s syndrome
  2. Destruction of ovaries because of local radiotherapy, chemotherapy.

6. What are the features of delayed puberty?

The girls fail to develop breast enlargement, fail to experience pubertal growth spurt, menstrual periods.

7. What tests are done to know the cause?

The doctor orders for several hormones and scans. Some are done after giving stimulating hormones. LH and FSH, the two pituitary hormones responsible for stimulating testes to secrete the female sex hormones -estradiol and prgesterone, are measured at base line and post GnRH injection. Blood levels of estradiol are done. To detect the genetic defect karyotyping is done. This test tells about the genetic makeup of the individual. MRI scan of the brain and/or abdomen are also done.

8. How to treat these patients?

Improving the nutrition in under nourished children is very important in that group. But if the problem is because of sex hormone deficiency then oral estrogen in small doses is given. If break through bleeding occurs then progesterone is added.

This article is prepared by Dr Rajiv Joshi
( and Dr A Bhattacharyya