Delayed puberty

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

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

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

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