Pubertal delay

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

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Overview

Delayed onset of puberty is considered 14 years old in girls and 15 years old in boys. Most frequently, the delay is due to a constitutional, non-pathologic delay in growth and puberty.

Causes

Common Causes

• Anorexia Nervosa
• Cardiac conditions
• Celiac Sprue
• Chronic infection
• Chronic metabolic disorder
• Chronic Renal Failure
• Cushing syndrome
• Heavy physical excercise
• Hyperprolactinemia
• Hypothyroidism
• Iatrogenic
• Inflammatory Bowel Disease
• Kallmann's Syndrome
• Kleinfelter's syndrome (Boys)
• Malignancy
• Malnutrition
• Multiple tropic hormone deficiency
• Noonan's Syndrome
• Prader-Willi Syndrome
• Somatotropin deficiency
• Turner's syndrome

Causes by Organ System

Cardiovascular	Cardiac conditions, Cyanotic congenital heart disease, Vascular lesions
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Alopecia, Ectodermal dysplasia, Mumps orchitis, Mumps
Drug Side Effect	Anabolic steroids, Cytotoxic drugs
Ear Nose Throat	No underlying causes
Endocrine	Addison's disease, Adrenal failure, Adrenal hypoplasia congenital, Combined pituitary hormone deficiency, Congenital adrenal hyperplasia, Congenital hypopituitarism, Congenital hypothyroidism , Constitutional delay , Cushing syndrome, Excess thyroid hormone consumption, Forbes disease , Froelich's syndrome , Growth hormone deficiency, Hydrocephalus obesity hypogonadism , Hyperthyroidism, Hypogonadism, Hypogonadotrophic hypogonadism, Hypopituitarism, Hypothalamic cyst, Hypothalamic damage, Hypothalamic dysfunction , Hypothalamic infection, Hypothalamus disease, Hypothyroidism, Infantile hypothyroidism , Laron pituitary dwarfism , Laron syndrome , Low body weight, Luteinizing hormone deficiency, Lyndi's syndrome, Multiple tropic hormone deficiency, Neuroectodermal endocrine syndrome , Niemann-pick disease , Panhypopituitarism , Pituitary adenoma, Pituitary gland abscess, Pituitary gland cyst, Pituitary gland damage, Pituitary gland infection, Pituitary gland tumor, Salti-salem syndrome, Spastic paraplegia with kallmann syndrome, Thyroid agenesis , Underactive thyroid gland, Woodhouse sakati syndrome
Environmental	No underlying causes
Gastroenterologic	Celiac disease, Celiac sprue, Collagenous celiac disease , Crohn's disease, Gluten enteropathy, Glycogen debranching deficiency , Inflammatory bowel disease, Tricho-hepato-enteric syndrome , Type iii glycogen storage disease
Genetic	Anorchism, Bangstad syndrome , Bassoe syndrome , Beta thalassemia , Biedl-bardet syndrome, Bird-headed dwarfism , Bosma-henkin-christiansen syndrome , Bullous dystrophy, Camurat-engelmann disease, Cantu sanchez-corona fragoso syndrome , Chromophobe adenoma, Chromosome 13 ring syndrome , Chromosome 14 uniparental disomy syndrome , Chromosome 3, monosomy 3p2, Chromosome 9, trisomy 9p , Cockayne syndrome type 1, Cohen syndrome , Crandall syndrome , Craniopharyngioma, Eunuchoidism familial, Fabry disease, Familial dysautonomia , Fleisher syndrome , Fshb mutation, Haspeslagh fryns muelenaere syndrome , Image syndrome , Kallmann's syndrome, Kleinfelter's syndrome, Lack of gonadotrophin-releasing hormone, Laurence-moon-biedl syndrome, Malouf syndrome , Mandibuloacral dysplasia , Marinesco-sjogren syndrome , Noonan's syndrome, Prader-willi syndrome, Prenatal dwarfism , Richards-rundle syndrome, Schaap-taylor-baraitser syndrome , Schofer beetz bohl syndrome , Sengers-hamel-otten syndrome , Shprintzen-golberg craniosynostosis , Singh-chhaparwal-dhanda syndrome, Sohval-soffer syndrome , Spastic paraplegia with kallmann syndrome, Turner's syndrome, Woodhouse sakati syndrome
Hematologic	Alpha thalassemia, Anemia, Beta thalassemia , Chondrodysplasia punctata with steroid sulfatase deficiency , Congenital spherocytic hemolytic anemia , Diamond-blackfan anemia , Hyperprolactinemia, Insulin-resistance syndrome, Isolated gonadotropin deficiency, Lymphangiectasies , Lymphoedema , Malabsorption syndrome, Prolactinoma, Pure red cell aplasia, Sickle cell anemia , Somatotropin deficiency, Type 1 diabetes , Type iii glycogen storage disease
Iatrogenic	Iatrogenic, Radiation therapy, X-irradiation
Infectious Disease	Chronic infection, Hypothalamic infection, Infections, Mumps orchitis, Mumps, Persistent major infection, Pituitary gland abscess, Pituitary gland cyst, Pituitary gland infection, Tuberculosis
Musculoskeletal/Orthopedic	Ataxia, Cystic fibrosis, Fibromatosis multiple non ossifying , Metaphyseal undermodeling, Myopathy , Spinocerebellar ataxia
Neurologic	Biemond syndrome type 2 , Bosma-henkin-christiansen syndrome , Cantu sanchez-corona fragoso syndrome , Central nervous system tumours, Craniopharyngioma, Deafness neurosensory, Familial dysautonomia , Froelich's syndrome , Hall-riggs mental retardation syndrome, Hersh-podruch-weisskopk syndrome, Meningioma, Mental retardation, Microcephaly , William's syndrome
Nutritional/Metabolic	Celiac disease, Celiac sprue, Chronic metabolic disorder, Collagenous celiac disease , Fabry disease, Insulin-resistance syndrome, Kwashiorkor , Malabsorption syndrome, Malnutrition, Niemann-pick disease , Type 1 diabetes , Zinc deficiency
Obstetric/Gynecologic	Autoimmune ovarian failure , Female reproductive toxicity , Intrauterine growth retardation, Müllerian agenesis, Ovarian cysts, Ovarian dysgenesis, Ovarian torsion, Prenatal dwarfism , Serious ovarian infection, Serious testicular infection, Ulnar-mammary syndrome of pallister
Oncologic	Chemotherapy, Germinoma, Glioma, Malignancy, Masculinizing tumor of ovary, Meningioma, Optic chiasma glioma, Pituitary adenoma, Pituitary gland tumor, Prolactinoma
Ophthalmologic	Anophthalmia , Optic chiasma glioma, Pterygia , Resistant ovary syndrome, Retinitis pigmentosa
Overdose/Toxicity	Female reproductive toxicity
Psychiatric	Anorexia nervosa, Bulimia nervosa, Serious emotional stress
Pulmonary	Tuberculosis
Renal/Electrolyte	Chronic renal failure
Rheumatology/Immunology/Allergy	Autoimmune disease, Autoimmune ovarian failure , Autoimmune thyroid disease , Connective-tissue diseases, Cystic fibrosis, Fibromatosis multiple non ossifying , Gluten enteropathy, Granulomas, Juvenile arthritis, Refractory celiac disease
Sexual	No underlying causes
Trauma	Castration, Excessive exercise, Head trauma, Heavy physical excercise, Pituitary gland damage, Trauma
Urologic	Adiposogenital dystrophy, Anorchism, Castration, Cataract deafness hypogonadism , Frasier syndrome, Germinoma, Gonadal dysgenesis epibulbar dermoid, Gonadotropin deficiency, Ichthyosis male hypogonadism , Mixed gonadal dysgenesis, Primary gonadal failure, Pure dysgenesis, Torsion of the testis, Undescended testes
Miscellaneous	Chronic illness

Causes in Alphabetical Order

• Addison's disease
• Adiposogenital dystrophy
• Adrenal failure
• Adrenal hypoplasia congenital
• Alopecia
• Alpha thalassemia
• Anabolic steroids
• Anemia
• Anophthalmia
• Anorchism
• Anorexia nervosa
• Ataxia
• Autoimmune disease
• Autoimmune ovarian failure
• Autoimmune thyroid disease
• Bangstad syndrome 
• Bassoe syndrome 
• Beta thalassemia 
• Biedl-bardet syndrome
• Biemond syndrome type 2 
• Bird-headed dwarfism
• Bosma-henkin-christiansen syndrome 
• Bulimia nervosa
• Bullous dystrophy
• Camurat-engelmann disease
• Cantu sanchez-corona fragoso syndrome 
• Cardiac conditions
• Castration
• Cataract deafness hypogonadism 
• Celiac disease
• Celiac sprue
• Central nervous system tumours
• Chemotherapy
• Chondrodysplasia punctata with steroid sulfatase deficiency 
• Chromophobe adenoma
• Chromosome 13 ring syndrome 
• Chromosome 14 uniparental disomy syndrome 
• Chromosome 3, monosomy 3p2
• Chromosome 9, trisomy 9p 
• Chronic illness
• Chronic infection
• Chronic metabolic disorder
• Chronic renal failure
• Cockayne syndrome type 1
• Cohen syndrome 
• Collagenous celiac disease 
• Combined pituitary hormone deficiency
• Congenital adrenal hyperplasia
• Congenital hypopituitarism
• Congenital hypothyroidism 
• Congenital spherocytic hemolytic anemia 
• Connective-tissue diseases
• Constitutional delay
• Crandall syndrome 
• Craniopharyngioma
• Crohn's disease
• Cushing syndrome
• Cyanotic congenital heart disease
• Cystic fibrosis
• Cytotoxic drugs
• Deafness neurosensory
• Diamond-blackfan anemia 
• Ectodermal dysplasia
• Eunuchoidism familial
• Excess thyroid hormone consumption
• Excessive exercise
• Fabry disease
• Familial dysautonomia 
• Female reproductive toxicity 
• Fibromatosis multiple non ossifying 
• Fleisher syndrome 
• Forbes disease 
• Frasier syndrome
• Froelich's syndrome 
• Fshb mutation
• Germinoma
• Glioma
• Gluten enteropathy
• Glycogen debranching deficiency 
• Gonadal dysgenesis epibulbar dermoid
• Gonadotropin deficiency
• Granulomas
• Growth hormone deficiency
• Hall-riggs mental retardation syndrome
• Haspeslagh fryns muelenaere syndrome 
• Head trauma
• Heavy physical excercise
• Hersh-podruch-weisskopk syndrome
• Hydrocephalus obesity hypogonadism 
• Hyperprolactinemia
• Hyperthyroidism
• Hypogonadism
• Hypogonadotrophic hypogonadism
• Hypopituitarism
• Hypothalamic cyst
• Hypothalamic damage
• Hypothalamic dysfunction 
• Hypothalamic infection
• Hypothalamus disease
• Hypothyroidism
• Iatrogenic
• Ichthyosis male hypogonadism 
• Image syndrome 
• Infantile hypothyroidism 
• Infections
• Inflammatory bowel disease
• Insulin-resistance syndrome
• Intrauterine growth retardation
• Isolated gonadotropin deficiency
• Juvenile arthritis
• Kallmann's syndrome
• Kleinfelter's syndrome
• Kwashiorkor 
• Lack of gonadotrophin-releasing hormone
• Laron pituitary dwarfism 
• Laron syndrome 
• Laurence-moon-biedl syndrome
• Low body weight
• Luteinizing hormone deficiency
• Lymphangiectasies
• Lymphoedema
• Lyndi's syndrome
• Malabsorption syndrome
• Malignancy
• Malnutrition
• Malouf syndrome 
• Mandibuloacral dysplasia 
• Marinesco-sjogren syndrome 
• Masculinizing tumor of ovary
• Meningioma
• Mental retardation
• Metaphyseal undermodeling
• Microcephaly
• Mixed gonadal dysgenesis
• Müllerian agenesis
• Multiple tropic hormone deficiency
• Mumps
• Mumps orchitis
• Myopathy
• Neuroectodermal endocrine syndrome 
• Niemann-pick disease 
• Noonan's syndrome
• Optic chiasma glioma
• Ovarian cysts
• Ovarian dysgenesis
• Ovarian torsion
• Panhypopituitarism 
• Persistent major infection
• Pituitary adenoma
• Pituitary gland abscess
• Pituitary gland cyst
• Pituitary gland damage
• Pituitary gland infection
• Pituitary gland tumor
• Prader-willi syndrome
• Prenatal dwarfism
• Primary gonadal failure
• Prolactinoma
• Pterygia
• Pure dysgenesis
• Pure red cell aplasia
• Radiation therapy
• Refractory celiac disease 
• Resistant ovary syndrome
• Retinitis pigmentosa
• Richards-rundle syndrome
• Salti-salem syndrome
• Schaap-taylor-baraitser syndrome 
• Schofer beetz bohl syndrome 
• Sengers-hamel-otten syndrome 
• Serious emotional stress
• Serious ovarian infection
• Serious testicular infection
• Shprintzen-golberg craniosynostosis 
• Sickle cell anemia 
• Singh-chhaparwal-dhanda syndrome
• Sohval-soffer syndrome 
• Somatotropin deficiency
• Spastic paraplegia with kallmann syndrome
• Spinocerebellar ataxia
• Thyroid agenesis 
• Torsion of the testis
• Trauma
• Tricho-hepato-enteric syndrome 
• Tuberculosis
• Turner's syndrome
• Type 1 diabetes
• Type iii glycogen storage disease
• Ulnar-mammary syndrome of pallister
• Underactive thyroid gland
• Undescended testes
• Vascular lesions
• William's syndrome
• Woodhouse sakati syndrome 
• X-irradiation
• Zinc deficiency 

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