Pediatric Delayed Puberty

The field of pediatric endocrinology handles a wide variety of hormonal issues and disorders. Often the issues involve a problem with the thyroid gland, pituitary gland, as well as broader conditions such as Diabetes or issues with Vitamin D.

Perhaps one of the most common issues dealt with in pediatric endocrinology is delayed puberty. It can be a particularly stressful time in a person's life. The teenage years are a formative time both physically and psychologically. Many people carry the scars of socially challenging conditions from their adolescence all the way into adulthood.

When an adolescent is not developing and everyone around them is, they can end up in a situation where their peers do not treat them with respect and ridicule them for their childlike appearance.

Hormones secreted from the pituitary gland called gonadotropin trigger puberty. Gonadotropin creates growth in the sex glands. These glands issue testosterone in males and estrogen in females. The hormones trigger certain effects like facial hair and overall muscle growth in males. In females, the hormones stimulate the growth of breasts. The first menstrual cycle occurs two to three years later.

Most adolescents begin puberty at the age of 11 or 12 years old. Sometimes it starts much earlier. Girls sometimes begin at the age of 7 and boys at the age of 9. For some, puberty sets in much later than most. This condition is known as delayed puberty.

Delayed puberty occurs in about 3% of children. Symptoms often include an absence of testicle growth in males by the age of 14. For girls, it is defined as a delay in the onset of menstruation in females coupled with underdeveloped breasts by the age of 13. If a female has not begun menstruating by the age of 16, they are also considered to be suffering from delayed puberty.

There are many different causes of delayed puberty. Most commonly, the issue is simply genetic. This is known as constitutional delay, a naturally occurring condition that is simply a "late start", developmentally speaking. Usually, when a parent or close relative went through a delay, so does the child. The teenagers develop normally; it just happens a bit later than other kids do.

Diseases such as cystic fibrosis and diabetes can cause delayed puberty. Illnesses like these pose various difficulties in the body, which hampers the growth process. Effective treatment of these diseases often lowers the risk of delayed puberty.

Those who did not have enough food growing up sometimes end up with delayed puberty. Young teens with an eating disorder are especially vulnerable. Girls who play a lot of sports experience delayed puberty as a girl's body needs a healthy amount of fat before the puberty process can begin. It is quite common to see female gymnasts, dancers and swimmers go through a delay in their development.

There are a number of syndromes, which affect the onset of puberty. Turner syndrome affects many women, causing not only a delay but it also makes them shorter and infertile. Klinefelter syndrome affects males and is known to slow the development process.

There are many less common causes as well. Some medical conditions like celiac disease prevent the intestines from absorbing nutrients are linked to delayed puberty. Sometimes cancer treatments can affect sex hormone production. Certain stimulants that are used to treat attention deficit hyperactivity disorder can also be a cause.

In rare cases, a tumor is the source of the problem and might have to be removed. Prolactinoma and glioma are linked to delayed puberty in select cases.

Treatments are generally very effective and in many cases can cause an onset of the maturation process. Doctors can help assess teens who are suffering from delayed puberty. The actual diagnosis is quite simple as the physician can determine the delay through a physical examination. A follow-up assessment involves blood tests and possibly a "bone age" X-ray to see if the skeleton is developing, as it should.

Most of the time, there is no serious medical cause behind delayed puberty. If there is an issue, the patient will be sent to see an endocrinologist for further testing.

Treatment depends on the cause. In most cases, boys may be given testosterone for up to six months. Testosterone can induce puberty and will enable them to reach their adult height potential. Females can receive estrogen in small doses through pills or other delivery methods. Hormone therapy can aid in the development of sexual characteristics.

Coping with delayed puberty properly is important to the mental health of the individual. Being a teenager is a difficult, awkward time to begin with. Being put in a situation where your friends are developing and you are not is especially troublesome. These situations can lead to depression or other issues. It is important to monitor those going through delayed puberty and to offer them support through the ordeal.

Boys in particular have a difficult time dealing with delayed puberty. Other teenagers will think of him as a little kid and are more likely to tease him. Some males do not grow any body hair at all until the age of 16. They are frequently too small to play sports like hockey and soccer.

In general, girls with delayed puberty have less of a hard time, although the delay in onset of menstruation can lead to very traumatic, embarrassing situations.

The key to minimizing the negative effects of a delay in puberty is to handle it as soon as the issue arises. The process of puberty rolls out over a number of years. The sooner it is initiated, the sooner the issue can be resolved.