Delayed puberty
Reassure
- Puberty started after age eight in girls, after age nine in boys
- No excess fluid intake or urine production
- No symptoms of raised intracranial pressure
- No associated high risk conditions.
- Normal examination
Action
Reassure
Review / Refer
- Early/precocious puberty (before age eight in girls and before age nine in boys)
- Delayed puberty (no signs of breast development by 13 or no periods by 16 in girls, and no signs of puberty by 15 in boys)
- Discordant puberty (pubic hair starting before breast/testicular development)
- Any risk factors for a brain tumour
- Galactorrhoea
- Secondary amenorrhoea
Action
Refer for specialist paediatric endocrine assessment
Scan
- Early, delayed or arrested puberty, and;
- Excess fluid intake and urine production, or;
- One or more other symptoms attributable to a brain tumour, or;
- Abnormal neurological examination
Action
Scan
Examination/assessment
- Determine how long patient/parents/carers have had concerns about pubertal status
- Ask about family history of early/delayed puberty
- Ask specifically about associated symptoms and risk factors for brain tumours
- Determine pubertal status
- Check testicular volume in boys
- Plot height and weight on growth chart
- Neurological examination
- Full visual assessment