Constitutional delay of puberty pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

Normal timing

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.

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

• 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.