Delayed or Stalled Pubertal Development

Abstract

Delayed puberty is defined as lack of development of secondary sexual characteristics in girls by age 13 years or boys by age 14 years. Stalled pubertal development is not defined using precise thresholds but is characterized by failure to continue pubertal progression after onset of puberty. The differential diagnosis of delayed or stalled puberty is divided into dysfunction in the testes or ovaries (hypergonadotropic hypogonadism) or dysfunction in hypothalamic or pituitary signaling (hypogonadotropic hypogonadism), with the latter category also including the most common cause of delayed puberty, the benign entity of constitutional delay of growth and puberty. Although most cases of delayed puberty will be benign and self-limited, delayed or stalled puberty can be a presenting sign of underlying illness or central nervous system pathology. This chapter discusses the differential diagnosis and initial approach to delayed or stalled puberty, with particular attention to critical aspects of the history, physical, and initial evaluation.