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Encyclopedia > Delayed puberty
Delayed puberty
Classification & external resources
ICD-10 E30.0
ICD-9 259.0
DiseasesDB 17462
MeSH D011628

Puberty is described as delayed when a boy or girl has passed the usual age of onset of puberty with no physical or hormonal signs that it is beginning. Puberty may be delayed for several years and still occur normally, in which case it is considered constitutional delay, a variation of healthy physical development. Delay of puberty may also occur due to undernutrition, many forms of systemic disease, or to defects of the reproductive system (hypogonadism) or the body's responsiveness to sex hormones. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Puberty refers to the process of physical changes by which a childs body becomes an adult body capable of reproduction. ... Norepinephrine A hormone (from Greek όρμή - to set in motion) is a chemical messenger from one cell (or group of cells) to another. ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ... The term disease refers to an abnormal condition of an organism that impairs function. ... The reproductive system is the ensembles and interactions of organs and/or substances within an organism that strictly pertain to reproduction. ... Hypogonadism is a medical term for a defect of the reproductive system which results in lack of function of the gonads (ovaries or testes). ... Sex hormones are hormones that affect the reproductive system. ...

Contents

What’s the normal timing of puberty and what's delayed?

Approximate mean ages for onset of various pubertal changes are as follows. Ages in parentheses are the approximate 3rd and 97th percentiles for attainment. For example, less than 3% of girls have not yet achieved thelarche by 13 years of age. Developmental changes during puberty in girls occur over a period of 3 - 5 years, usually between 9 and 14 years of age. They include the occurrence of secondary sex characteristics beginning with breast development, the adolescent growth spurt, the onset of menarche - which does not correspond to the end of puberty - and the acquisition of fertility, as well as profound psychological modifications. Thelarche is the first stage of secondary (postnatal) breast development, usually occurring at the beginning of puberty in girls. ... Puberty refers to the process of physical changes by which a childs body becomes an adult body capable of reproduction. ... Menarche (IPA: ) is the first menstrual period, or first menstrual bleeding. ... Fertility is a measure of reproduction: the number of children born per couple, person or population. ...


The normal variation in the age at which adolescent changes occur is so wide that puberty cannot be considered to be pathologically delayed until the menarche has failed to occur by the age of 17 or testicular development by the age of 20.


For North American, Indo-Iranian(India, Iran) and European girls

  • Thelarche 10y5m (8y-13y)
  • Pubarche 11y (8.5-13.5y)
  • Growth spurt 10-12.5y
  • Menarche 12.5y (10.5-14.5)
  • Adult height reached 14.5y

For North American, Indo-Iranian(India, Iran) and European boys Thelarche is the first stage of secondary (postnatal) breast development, usually occurring at the beginning of puberty in girls. ... Pubarche refers to the first appearance of pubic hair in a child. ...

  • Testicular enlargement 11.5y (9.5-13.5y)
  • Pubic hair 12y (10-14y)
  • Growth spurt 12.5-15y
  • Completion of growth 17.5

The sources of the data, and a fuller description of normal timing and sequence of pubertal events, as well as the hormonal changes that drive them, are provided in the principal article on puberty. Norepinephrine A hormone (from Greek όρμή - to set in motion) is a chemical messenger from one cell (or group of cells) to another. ... Puberty refers to the process of physical changes by which a childs body becomes an adult body capable of reproduction. ...


How is delayed puberty evaluated?

Obviously anyone who is later than average is late in the ordinary sense. There are three indications that pubertal delay may be due to an abnormal cause. The first is simply degree of lateness: although no recommended age of evaluation cleanly separates pathologic from physiologic delay, a delay of 2-3 years or more warrants evaluation.

  • In girls, no breast development by 13 years, or no menarche by 3 years after breast development (or by 16).
  • In boys, no testicular enlargement by 14 years.

The second indicator is discordance of development. In most children, puberty proceeds as a predictable series of changes in specific order. In children with ordinary constitutional delay, all aspects of physical maturation typically remain concordant but a few years later than average. If some aspects of physical development are delayed, and others are not, there is likely something wrong. For instance, in most girls, the beginning stages of breast development precede pubic hair. If a 12 year old girl were to reach Tanner stage 3 pubic hair for a year or more without breast development, it would be unusual enough to suggest an abnormality such as defective ovaries. Similarly, if a 13 year old boy had reached stage 3 or 4 pubic hair with testes that still remained prepubertal in size, it would be unusual and suggestive of a testicular abnormality. The Tanner stages (also known as the Tanner scale) are stages of physical development in children, adolescents and adults. ...


The third indicator is the presence of clues to specific disorders of the reproductive system. For example, malnutrition or anorexia nervosa severe enough to delay puberty will give other clues as well. Poor growth would suggest the possibility of hypopituitarism or Turner syndrome. Reduced sense of smell (hyposmia) suggests Kallmann syndrome. The reproductive system is the ensembles and interactions of organs and/or substances within an organism that strictly pertain to reproduction. ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ... For the symphonic black metal band, see Anorexia Nervosa (band) Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion with an obsessive fear of gaining weight. ... Hypopituitarism is a medical term describing deficiency (hypo) of one or more hormones of the pituitary gland. ... Hyposmia is a reduced ability to smell and to detect odors. ... Kallmann syndrome is an example of hypogonadism (decreased functioning of the sex hormone-producing glands) caused by a deficiency of gonadotropin-releasing hormone (GnRH), which is created by the hypothalamus. ...


Some possible causes of delayed puberty

In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... For the symphonic black metal band, see Anorexia Nervosa (band) Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion with an obsessive fear of gaining weight. ... Prader-Willi syndrome is a genetic disorder, in which seven genes (or some subset thereof) on chromosome 15 are missing or unexpressed (chromosome 15q partial deletion) on the paternal chromosome. ... Hypopituitarism is a medical term describing deficiency (hypo) of one or more hormones of the pituitary gland. ... Kallmann syndrome is an example of hypogonadism (decreased functioning of the sex hormone-producing glands) caused by a deficiency of gonadotropin-releasing hormone (GnRH), which is created by the hypothalamus. ... XXY karyotype Klinefelters syndrome is a condition caused by a chromosome abnormality in males (specifically, a nondisjunction); sufferers have a pair of X sex chromosomes instead of just one. ... Androgen insensitivity syndrome (AIS, or Androgen resistance syndrome) is a set of disorders of sexual differentiation that results from mutations of the gene encoding the androgen receptor. ... Mullerian agenesis refers to a condition in a female where the mullerian ducts fail to develop and a uterus will not be present. ... This article or section does not cite its references or sources. ...

Constitutional delay of puberty

Children who are healthy but have a slower rate of physical development than average have constitutional delay in growth and adolescence. These children have a history of stature shorter than their age-matched peers throughout childhood, but their height is appropriate for bone age, and skeletal development is delayed more than 2.5 SD. They usually are thin and often have a family history of delayed puberty. Children with a combination of a family tendency toward short stature and constitutional delay are the most likely to seek evaluation. They quite often seek evaluation when classmates or friends undergo pubertal development and growth, thereby accentuating their delay.


Medical evaluation of delayed puberty

Pediatric endocrinologists are the physicians with the most training and experience evaluating delayed puberty. Pediatric endocrinology is a medical subspecialty dealing with variations of physical growth and sexual development in childhood, as well as diabetes and other disorders of the endocrine glands. ...


A complete medical history, review of systems, growth pattern, and physical examination will reveal most of the systemic diseases and conditions capable of arresting development or delaying puberty, as well as providing clues to some of the recognizable syndromes affecting the reproductive system. In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ...


Since bone maturation is a good indicator of overall physical maturation, an x-ray of the hand to assess bone age usually reveals whether the child has reached a stage of physical maturation at which puberty should be occurring. Visible secondary sexual development usually begins when girls achieve a bone age of 10.5 to 11 years, and boys achieve a bone age of 11.5 to 12 years. Grays Anatomy illustration of a human femur. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... Bone age is a way of describing the degree of maturation of a childs bones. ... Bone age is a way of describing the degree of maturation of a childs bones. ...


The most valuable blood tests are the gonadotropins, because elevation confirms immediately a defect of the gonads or deficiency of the sex steroids. In many instances, screening tests such as a complete blood count, general chemistry screens, thyroid tests, and urinalysis may be worthwhile. Gonadotropins are protein hormones secreted by gonadotrope cells of the pituitary gland of vertebrates. ... The gonad is the organ that makes gametes. ... Sex steroids, also known as gonadal steroids, are steroid hormones which interact with vertebrate androgen or estrogen receptors. ... A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... A urinalysis (or UA) is an array of tests performed on urine and one of the most common methods of medical diagnosis. ...


More expensive and complicated tests, such as a karyotype or magnetic resonance imaging of the head, are usually obtained only when specific evidence suggests they may be useful. Karyogram of human male using Giemsa staining. ... Magnetic Resonance Image showing a median sagittal cross section through a human head. ...


Management of delayed puberty

If a child is healthy but simply late, reassurance and prediction based on the bone age can be provided. No other intervention is usually necessary. In more extreme cases of delay, or cases where the delay is more extremely distressing to the child, a low dose of testosterone or estrogen for a few months may bring the first reassuring changes of normal puberty.


If the delay is due to systemic disease or undernutrition, the therapeutic intervention is likely to focus mainly on those conditions.


If it becomes clear that there is a permanent defect of the reproductive system, treatment usually involves replacement of the appropriate hormones (testosterone for boys, estradiol and progesterone for girls). Testosterone is a steroid hormone from the androgen group. ... Estradiol (17β-estradiol) (also oestradiol) is a sex hormone. ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ...


See also

Endocrinology is a branch of medicine dealing with disorders of the endocrine system and its specific secretions called hormones. ... Menarche (IPA: ) is the first menstrual period, or first menstrual bleeding. ... Precocious puberty means early puberty. ... Puberty refers to the process of physical changes by which a childs body becomes an adult body capable of reproduction. ... The Tanner stages (also known as the Tanner scale) are stages of physical development in children, adolescents and adults. ... Developmental milestones are tasks most children can perform at certain ages. ...

References

  • Traggiai C, Stanhope R (2003). "Disorders of pubertal development". Best Pract Res Clin Obstet Gynaecol 17 (1): 41-56. PMID 12758225. 
  • Patrick Fenichel: Delayed Puberty Centre Hospitalo-Universitaire de Nice, Hôpital de L’Archet, Nice, France
  • Jungmann E, Trautermann C: The status of the gonadotropin-releasing hormone test in differential diagnosis of delayed puberty in adolescents over 14 years of age. Med Klin 1994;89:529–533.
  • Johannessonm M, Gottlieb C, Hjelte L: Delayed puberty in girls with cystic fibrosis despite good clinical status. Pediatrics 1997;1:29–34.
  • Layman LC, Lee EJ, Peak DB, Namnoum AB, Vu KV, Van Lingen B, et al: Delayed puberty and hypogonadism caused by mutations in the follicle-stimulating hormone β-subunit gene. N Engl J Med 1997;337:607–611.
  • Heinrichs C, Bourguignon JP: Treatment of delayed puberty and hypogonadism in girls. Horm Res 1991;36:147–152.

  Results from FactBites:
 
Delayed Puberty - Lucile Packard Children's Hospital (422 words)
Puberty is said to be delayed when symptoms do not appear by age 13 for girls and age 14 for boys.
Delayed puberty can be hereditary; the late onset of puberty may run in the families.
However, delayed puberty may also be due to chromosomal abnormalities, genetic disorders, chronic illnesses, or tumors that damage the pituitary gland or the hypothalamus, which affect maturation.
Floridian: Puberty different for every child (759 words)
The onset of puberty is triggered by the pituitary gland, a pea-size structure at the base of the brain that is under the influence of the hypothalamus gland.
Puberty is considered to be delayed when physical changes do not appear by age 13 for girls and age 14 for boys.
This means that the delay in puberty is hereditary; often parents or close relatives also had a history of delayed puberty and a similar growth pattern.
  More results at FactBites »

 
 

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