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Obstetrics

Delayed Puberty and Sexual Development

Puberty is a phase of rapid growth and development that involves physical growth and sexual maturation, along with psychological and social development. The normal age of puberty in girls is 8-12 years whereas in boys it is 10-14 years. A condition in which puberty is deferred beyond the average age of puberty is called delayed puberty.

Generally puberty is a result of increased hormonal levels in the body, stimulated by the hypothalamic-pituitary-gonadal axis. This stimulation triggers the hypothalamus to secrete gonadotropin-releasing hormone (GnRH). In response to GnRH, the pituitary gland starts releasing luteinizing hormone (LH), which induces the special cells present in the testes and ovaries to produce sex hormones, i.e. testosterone and oestrogen respectively. The increased levels of the specific sex hormones are responsible for the development of secondary sexual characteristics.

The signs of puberty in girls include:

  • Breast development
  • Menstrual cycle
  • Appearance of underarm and pubic hair
  • Rapid growth such as increase in height
  • Acne

The signs of puberty in boys include:

  • Deepening of voice
  • Appearance of underarm, chest, facial and pubic hair
  • Rapid growth such as increase in height
  • Enlarged penis and testes
  • Acne
  • Increase in muscles mass
  • Ejaculation in which semen is ejected from the penis

Causes

The delay in puberty and sexual development can occur due to chronic diseases, abnormal chromosomes, and many other factors. In some cases puberty may take longer time than the peers, but finally is achieved; this is called constitutional delay. The possible causes for delayed puberty are as follows:

  • Chronic diseases such as diabetes mellitus, inflammatory bowel disease, kidney disease, cystic fibrosis, kallaman’s syndrome and autoimmune diseases
  • Conditions such as anaemia, hypopituitarism and malnutrition
  • Chronic infections
  • Cancer
  • Chromosomal abnormalities such as turner syndrome, Klinefelter syndrome, Noonan syndrome and Prader-Willi syndrome
  • Certain radiation therapy and chemotherapy
  • Robust training exercises

Diagnosis

The diagnosis of delayed puberty involves physical examination, family history and medical history of the child. The bone growth can be assessed by taking X-rays of the wrist bone. Based on the results and underlying condition, other tests may be ordered that include:

  • Chromosomal analysis
  • Hormonal level such as FSH, LH, and oestrogen in girls and testosterone in boys
  • MRI scan of head and pituitary gland for detecting tumours or lesions
  • Ultrasound of pelvic region (female)
  • GnRH stimulation test
  • Diet and nutrition assessment
  • X-rays of the skull
  • Smell and vision tests

Treatment

The treatment of delayed puberty depends on the underlying cause. The underlying diseases responsible for delayed puberty are to be treated. Hormonal replacement therapy is recommended for those who are suffering from chromosomal abnormalities. Psychological support with certain medications is also recommended in children with delayed puberty.

In some cases surgery may be employed such as with turner syndrome in girls, where ovaries of the affected girl are surgically removed to avoid the risk of developing cancer.

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