Delayed puberty

The absence of expected pubertal development (secondary sexual characteristics and gonadal maturation) beyond an age ≥2–2.5 standard deviations above the population mean, commonly defined as no thelarche by ~13 years in girls or no testicular enlargement by ~14 years in boys.

Causes

• Central hypothalamic–pituitary disease

• Primary gonadal dysfunction

• Chronic systemic illness

• Malnutrition