Delayed puberty is defined clinically by the absence or incomplete development of secondary sexual characteristics bounded by an age at which 95% of children of that sex and culture have initiated sexual maturation. Delayed puberty usually results from inadequate gonadal steroid secretion which, in turn, is most often caused by a defective gonadotropin secretion from the anterior pituitary, due to defective production of gonadotropin-releasing hormone (GnRH) from the hypothalamus. Puberty leads to sexual maturation and reproductive capability. It requires an intact hypothalamic-pituitary-gonadal (HPG) axis.
Differential diagnosis of Delayed Puberty:
Delayed puberty typically speaks to an outrageous side of the ordinary range of pubertal time traverse, a formative example known as constitutional delay of growth and puberty (CDGP). In spite of the fact that CDGP mirrors the absolute most normal reason for delayed puberty in both genders, it can be analyzed simply in the wake of hidden conditions have been precluded.
The differential diagnosis of CDGP can be isolated into three primary classes: Hypergonadotropic Hypogonadism (portrayed by raised levels of luteinizing hormone and FSH offering ascend to the absence of negative input from the gonads), Permanent Hypogonadotropic Hypogonadism (described by low levels of luteinizing hormone and FSH which offers ascend to hypothalamic or pituitary issue), and Transient Hypogonadotropic Hypogonadism (practical hypogonadotropic hypogonadism), in which pubertal postponement is caused by deferred development of the HPG pivot optional to a hidden condition. The reason for CDGP is obscure, yet it has a solid association with the hereditary factor.
Management of delayed puberty:
Testosterone dose: The options for management of CDGP include expectant observation or therapy with low-dose testosterone (in boys) or estrogen (in girls). Testosterone can be administered by several routes, and in girls, estrogen may be given orally or transdermally, initially at doses below those used for replacement therapy in adults.
To increase sexual maturity: If puberty has started, clinically or biochemically, and stature is not a major concern, reassurance with realistic adult height prediction is frequently sufficient. The treatment leads to increased growth velocity and sexual maturation and positively affects psychosocial well-being, without significant side effects, rapid advancement of bone age, or reduced adult height.
Use of Growth Hormone: Although the Food and Drug Administration has approved the use of growth hormone for the treatment of idiopathic short stature, this therapy has at best a modest effect on adult height in adolescents with CDGP, and its use in CDGP is not recommended.