Paediatrics: Delayed puberty - assessment
This is defined as the lack of initiation and progress of pubertal development > +2 SD later than the average age of onset of puberty for the population.
Delayed puberty: assessment
This is defined as the lack of initiation and progress of pubertal development > +2 SD later than the average age of onset of puberty for the population. In the UK, this is to >14yrs for females and >16yrs for males.
A detailed history should screen for the many possible physical and functional causes of delayed puberty. Make a careful enquiry about the age at puberty onset (including menarche in females) in other family members.
- Measure height, weight, head circumference.
- Puberty (Tanner) staging.
- Review previous growth records if available.
- Measure parents’ heights and calculate MPH and family height target.
The following baseline screening tests should be carried out.
- LH and FSH levels.
- Sex hormone: oestrogen/testosterone.
- Karyotype (chromosomal abnormalities).
- Thyroid function tests.
- Routine biochemistry and inflammatory markers (e.g. CRP).
- BA X-ray.
- Pelvic US (ovarian morphology).
- Abdominal US (e.g. intra-abdominal testes).
- MRI scan brain.
- hCG stimulation test (3- or 21-day test): measurement of testosterone- and post-hCG (as an indicator of functional testicular tissue).
GnRH (LHRH) test: measurement of basal and post-GnRH LH and FSH levels (an indicator of hypothalamic-pituitary function).