Materiały źródłowe

• #1 Disorders of Puberty: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p590.html

  Disorders of puberty can profoundly impact physical and psychosocial well-being. Precocious puberty is pubertal onset before eight years of age in girls and before nine years of age in boys. Among patients with true precocious puberty, or full activation of the hypothalamic-pituitary-gonadal axis, most girls have an idiopathic etiology, whereas it is commonly due to identifiable pathology on imaging in boys. Delayed puberty is the absence of breast development in girls by 13 years of age and absence of testicular growth to at least 4 mL in volume or 2.5 cm in length in boys by 14 years of age. Constitutional delay of growth and puberty is a common cause of delayed puberty; however, functional or persistent hypogonadism should be excluded. Abnormal pubertal timing can adversely affect a child’s physical and psychosocial well-being and may be caused by a range of generally benign or pathologic etiologies.

• #1 What causes normal puberty, precocious puberty, & delayed puberty? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  https://www.nichd.nih.gov/health/topics/puberty/conditioninfo/causes

  Puberty is the body’s natural process of sexual maturation. Puberty’s trigger lies in a small part of the brain called the hypothalamus, a gland that secretes gonadotropin-releasing hormone (GnRH). GnRH stimulates the pituitary gland, a pea-sized organ connected to the bottom of the hypothalamus, to emit two hormones: luteinizing (pronounced LOO-tee-uh-nize-ing) hormone (LH) and follicle-stimulating hormone (FSH). These two hormones signal the female and male sex organs (ovaries and testes, respectively) to begin releasing the appropriate sex hormones, including estrogens and testosterone, which launch the other signs of puberty in the body. […] In the majority of cases of precocious puberty, no underlying cause can be identified. When a cause cannot be identified, the condition is called idiopathic precocious puberty. […] Sometimes the cause is an abnormality involving the brain. In other children, the signs of puberty occur because of a problem such as a tumor or genetic abnormality in the ovaries, testes, or adrenal glands, causing overproduction of sex hormones.

• #1 Delayed Puberty – Stanford Medicine Children’s Health

  https://deprod.stanfordchildrens.org/en/topic/default?id=delayed-puberty-90-P01947

  Puberty that happens late is called delayed puberty. This means a child’s physical signs of sexual maturity dont appear by age 12 in girls or age 14 in boys. Delayed puberty most often has no known cause. In some cases, it may run in families. In other cases, it may be caused by any of these: Chromosomal problems, Genetic disorder, Chronic illness, Tumors of the pituitary gland or hypothalamus, Underactive pituitary gland (hypopituitarism), Underactive thyroid (hypothyroidism), Abnormal development of the reproductive system, Inability of the body to use androgen hormones (complete androgen insensitivity syndrome), Too much exercise, Severe lack of eating (anorexia). […] Treatment depends on the cause of the problem. In many cases, when the cause is treated, puberty proceeds normally.

• #1

  https://www.archivesofmedicalscience.com/Central-precocious-puberty-etiology-with-particular-consideration-of-neurological,121051,0,2.html

  The cause of CPP remains undetected among girls in more than 90% of cases (idiopathic precocious puberty). Idiopathic precocious puberty is significantly less prevalent among boys and CPP is mostly the result of lesions in the CNS. […] Long-term exposure to sex steroids (in the case of congenital adrenal hyperplasia, testotoxicosis and sex steroid-producing tumors) can result in secondary CPP. Sex steroids can lead to maturation of CNS centers. The decrease in these hormones during treatment of the primary underlying disorder causes activation of the precociously matured hypothalamic GnRH pulse generator via feedback mechanisms.

• #1 Early or delayed puberty

  https://www.nhs.uk/conditions/early-or-delayed-puberty/

  In some cases, early puberty or delayed puberty could be a sign of an underlying condition that may need to be treated. […] It’s not always clear what causes early puberty. It may just be a tendency that runs in your family. […] Occasionally it can be caused by a problem in the brain, such as a brain tumour. […] Early puberty mostly affects girls and often has no obvious cause. It’s less common in boys and may be more likely to be associated with an underlying problem. […] It’s not always clear what causes delayed puberty. It may just be a tendency that runs in your family. Delayed puberty is generally more common in boys. […] Occasionally it can be caused by a long-term illness, such as cystic fibrosis, diabetes or kidney disease.

• #1 Precocious puberty – Wikipedia

  https://en.wikipedia.org/wiki/Precocious_puberty

  Secondary sexual development induced by sex steroids from other abnormal sources is referred to as peripheral precocious puberty or precocious pseudopuberty. […] Causes can include: Endogenous sources such as gonadal tumors (such as arrhenoblastoma), adrenal tumors, germ cell tumor, congenital adrenal hyperplasia, McCune-Albright syndrome, Silver-Russell syndrome, familial male-limited precocious puberty (testotoxicosis). […] Although the causes of early puberty are still somewhat unclear, girls who have a high-fat diet and are not physically active or are obese are more likely to physically mature earlier. […] In addition to diet and exercise habits, exposure to chemicals that mimic estrogen (known as xenoestrogens) is another possible cause of early puberty in girls. […] Familial cases of idiopathic central precocious puberty (ICPP) have been reported, leading researchers to believe there are specific genetic modulators of ICPP. […] The gene MKRN3, which is a maternally imprinted gene, was first cloned by Jong et al. in 1999. MKRN3 has since been identified as a cause of premature sexual development or CPP.

• #1 Precocious Puberty – Early Puberty: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/21064-precocious-early-puberty

  Precocious puberty, or early puberty, means puberty that begins before age 8 in girls and before age 9 in boys. The cause of early puberty depends on the type. Treatment for the condition includes medications that can turn off the production of certain hormones. […] Precocious puberty has different causes depending on the type. […] Central precocious puberty occurs when your child’s brain releases GnRH too early, in turn causing their testes or ovaries to release androgens too early. In most cases, the cause of this especially in female children is unknown. Causes may include: Brain trauma, Brain tumors, Brain infections, Brain abnormalities, Radiation treatment. […] Issues with your child’s reproductive organs or adrenal glands cause peripheral precocious puberty. Causes may include: Ovary, testes or adrenal gland tumors, Tumors that release human chorionic gonadotropin (HCG), Genetic conditions, such as McCune-Albright syndrome, Severe hypothyroidism, Adrenal gland disorders, like congenital adrenal hyperplasia.

• #1 Precocious Puberty (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/precocious-puberty-pro

  Premature activation of the hypothalamic-pituitary-gonadal (HPG) axis occurs. […] Idiopathic (sporadic or familial). No cause is found in 80% of girls and 40% of boys. […] Abnormalities of the central nervous system (CNS) include: Tumours, including gliomas, astrocytomas, hamartomas, pineal tumours and hCG-secreting germ cell tumours. […] This precocious puberty is independent of gonadotrophin release and it accounts for about 20% of cases of precocious puberty; some of the specific causes are rare. […] The appearance of secondary sexual characteristics is due to the increased production of female or male hormones, which occurs independently of the maturation of the HPG axis. […] Causes include: Congenital adrenal hyperplasia (CAH). […] Tumours: HCG-secreting tumours in the liver (hepatomas, hepatoblastomas), choriocarcinomas (of gonads, pineal gland, mediastinum, etc) and adrenal tumours (rare).

• #1 Precocious puberty – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/precocious-puberty/symptoms-causes/syc-20351811

  Precocious puberty is when children’s bodies begin to change into adult bodies too soon. […] The cause of precocious puberty often can’t be found. Rarely, certain conditions, such as infections, hormone issues, tumors, brain issues or injuries, may cause precocious puberty. […] The cause of this type of precocious puberty often isn’t known. […] In rare cases, the following can cause central precocious puberty: A tumor in the brain or spinal cord. A change in the brain that’s present at birth. This could be fluid buildup, known as hydrocephalus, or a tumor that isn’t cancer, known as a hamartoma. Radiation to the brain or spinal cord. Injury to the brain or spinal cord. A rare genetic disease that affects bones and skin color and causes hormonal problems. This condition is called McCune-Albright syndrome. A group of genetic issues, called congenital adrenal hyperplasia, that involve the adrenal gland making atypical hormones. A condition called hypothyroidism in which the thyroid gland doesn’t make enough hormones.

• #1 Precocious Puberty: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/924002-overview

  CNS abnormalities associated with precocious puberty include the following: Tumors (eg, astrocytomas, gliomas, germ cell tumors secreting human chorionic gonadotropin [HCG]), Hypothalamic hamartomas, Acquired CNS injury caused by inflammation, surgery, trauma, radiation therapy, or abscess, Congenital anomalies (eg, hydrocephalus, arachnoid cysts, suprasellar cysts). […] A study by Dahl et al indicated that the risk of precocious or early puberty is high in girls who have had shunted infantile hydrocephalus.

• #1 Precocious Early Puberty | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/precocious-early-puberty

  When a child enters puberty (the process of becoming sexual mature) too early, it’s called precocious puberty, or early puberty. […] In girls, the cause of precocious puberty 90 to 95 percent of the time is idiopathic, or unknown, meaning doctors don’t know for certain why it happens. Boys are more likely to have an underlying identifiable cause. Early puberty and sexual development may be caused by: central nervous system abnormalities, family history of the disorder, certain rare genetic syndromes, tumors of the pituitary gland or brain. […] Peripheral precocious puberty may be caused by: certain rare genetic syndromes, tumors of the ovary or testis, other tumors that secrete human chorionic gonadotropin, disorders of the adrenal gland, severe hypothyroidism. […] The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of puberty. Treatment will also depend on the type of precocious puberty your child has and the underlying cause, if known.

• #1 Early or delayed puberty

  https://www2.hse.ie/conditions/early-or-delayed-puberty/

  There’s usually no need to worry if puberty does not start around the average age. But in some cases, early or delayed puberty could be a sign of an underlying condition that may need treatment. […] Early puberty is also called precocious puberty. […] It’s not always clear what causes early puberty. It may be something that runs in your family. […] Sometimes the cause can be: a problem with your child’s organs, such as their ovaries or thyroid gland; damage to your child’s brain as a result of an infection, surgery or radiotherapy; a genetic disorder, such as McCune-Albright syndrome; a problem in your child’s brain, such as a tumour. […] It’s not always clear what causes delayed puberty. It may be something that runs in your family. […] Sometimes the cause can be: a long-term illness, such as cystic fibrosis, kidney disease or diabetes; malnutrition, from a condition such as coeliac disease or an eating disorder; a problem with your child’s ovaries, testes, thyroid gland or pituitary gland; differences in sex development, such as androgen insensitivity syndrome; a genetic condition, such as Kallmann syndrome and Klinefelter syndrome.

• #1 Precocious Puberty – Early Puberty: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/21064-precocious-early-puberty

  Sometimes, exposure to hormones from sources outside your child’s body causes peripheral precocious puberty. For example, exposure to products like creams, medications or supplements containing estrogen, testosterone or androgen. […] Early puberty affects about 20 out of every 10,000 children female children. It affects fewer than 5 in every 10,000 male children. […] Precocious puberty treatment depends on the type. […] Turning off the pituitary glands production of LH and FSH is the main goal of central precocious puberty treatment. […] Eliminating the source of reproductive hormones is the treatment for peripheral precocious puberty. […] You can’t prevent most early puberty cases. Limiting your child’s exposure to reproductive hormones from outside sources may prevent it. These sources may include estrogen or testosterone creams, lotions or other medications.

• #1 Precocious Puberty – Early Puberty: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/21064-precocious-early-puberty

  In the United States, it may seem like more and more girls are hitting puberty early. This trend may be related to the increasing rate of obesity in the country. Researchers link a higher body mass index (BMI) to early breast development. Eating a lot of processed, high-fat foods may cause early puberty. […] Race and ethnicity also play a part in the early timing of puberty. Black and Hispanic female children typically begin puberty earlier than other ethnic groups. Because obesity typically affects these groups more prevalently, this may add to the increase in cases of early puberty.

• #1 Delayed puberty in girls: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/007694.htm

  Delayed puberty in girls occurs when breasts don’t develop by age 13 or menstrual periods do not begin by age 16. […] Puberty changes occur when the body starts making sex hormones. These changes normally begin to appear in girls between ages 8 to 14 years. […] With delayed puberty, these changes either don’t occur at the normal age, or if they do, they don’t progress normally. Delayed puberty is more common in boys than in girls. […] In most cases of delayed puberty, growth changes just begin later than usual, sometimes called a late bloomer. Once puberty begins, it progresses normally. This pattern runs in families. This is the most common cause of late maturity. […] Another common cause of delayed puberty in girls is lack of body fat. Being too thin can disrupt the normal process of puberty.

• #1 What causes normal puberty, precocious puberty, & delayed puberty? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  https://www.nichd.nih.gov/health/topics/puberty/conditioninfo/causes

  Many children with delayed puberty will eventually go through an otherwise normal puberty, just at a late age. Sometimes, this delay occurs because the child is just maturing more slowly than average, a condition called constitutional delay of puberty. This condition often runs in families. […] Puberty can be delayed in children who have not gotten proper nutrition due to long-term illnesses. Also, some young girls who undergo intense physical training for a sport, such as running or gymnastics, start puberty later than normal. […] In other cases, the delay in puberty is not just due to slow maturation but occurs because the child has a long-term medical condition known as hypogonadism (pronounced HI-poe-GO-nad-iz-uhm), in which the sex glands (the testes in men and the ovaries in women) produce few or no hormones. Hypogonadism can be divided into two categories: secondary hypogonadism and primary hypogonadism.

• #1 Delayed Puberty (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/delayed-puberty.html

  Delayed puberty, which is more common in boys, can happen for different reasons. […] Most often, delayed puberty is a pattern of growth and development in a family. A child’s parents, uncle, aunt, brothers, sisters, or cousins might have developed later than usual too. This is called constitutional delay and usually doesn’t need any treatment. These „late bloomers” in time will develop normally, just later than most of their peers. […] Some medical problems can cause delays in puberty: Some kids and teens with chronic illnesses like diabetes, cystic fibrosis, kidney disease, or even asthma may go through puberty at an older age. That’s because their illnesses can make it harder for their bodies to grow and develop. Proper treatment and better control of these conditions can help make delayed puberty less likely.

• #1 Delayed Puberty Signs & Treatment (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/delayed-puberty.html

  Puberty can be delayed for several reasons. […] Most often, it’s simply a pattern of growth and development in a family. A guy or girl may find that his or her parent, uncle, aunt, brothers, sisters, or cousins developed later than usual, too. This is called constitutional delay (or being a late bloomer), and it usually doesn’t need treatment. These teens in time will develop normally, just later than most of their peers. […] Medical problems also can cause delays in puberty. […] Some people with chronic illnesses like diabetes, cystic fibrosis, kidney disease, or even asthma may go through puberty at an older age. That’s because their illnesses can make it harder for their bodies to grow and develop. Proper treatment and better control of these conditions can help make delayed puberty less likely.

• #1 Delayed Puberty – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/endocrine-disorders-in-children/delayed-puberty

  Delayed puberty may result from constitutional delay, which often occurs in adolescents with a family history of delayed growth. […] Other causes of delayed puberty include genetic disorders (Turner syndrome in girls, Klinefelter syndrome in boys), central nervous system (CNS) disorders (eg, hypothalamic or pituitary tumors that reduce gonadotropin secretion), and other causes of hypogonadism. […] Chronic disorders that cause inadequate nutrition can delay puberty by impairing gonadotropin-releasing hormone release. […] About one third of cases of hypogonadotropic hypogonadism are genetic, and Kallman syndrome is the most common cause. […] Delayed puberty may represent constitutional delay or be caused by a variety of genetic or acquired disorders.

• #1 Delayed Puberty Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/delayed-puberty

  The role of hormones in delayed puberty: Hormones are chemical messengers that work behind the scenes to make puberty start and continue. Endocrine glands release these hormones. […] Hypogonadotropic hypogonadism. Your childs hypothalamus or pituitary gland isnt working right. Theyre not making or releasing enough hormones. This is often due to a medical condition. […] Hypergonadotropic hypogonadism. Your childs hypothalamus and pituitary gland are working fine. But their sex glands (testicles or ovaries) arent. This is what happens in children with Turner syndrome and Klinefelter syndrome.

• #1 What causes normal puberty, precocious puberty, & delayed puberty? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  https://www.nichd.nih.gov/health/topics/puberty/conditioninfo/causes

  Secondary hypogonadism (also known as central hypogonadism or hypogonadotropic hypogonadism), is caused by a problem with the pituitary gland or hypothalamus (part of the brain). In secondary hypogonadism, the hypothalamus and the pituitary gland fail to signal the gonads to properly release sex hormones. Causes of secondary hypogonadism include: Kallmann syndrome, a genetic problem that also diminishes the sense of smell. […] In primary hypogonadism, the problem lies in the ovaries or testes, which fail to make sex hormones normally. Some causes include genetic disorders, especially Turner syndrome (in women) and Klinefelter syndrome (in men).

• #1 Delayed Puberty Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/delayed-puberty

  Delayed puberty is when your childs sexual development doesnt start when expected or proceeds slowly. But certain medical conditions and other things can keep your childs hormones from working as they should. In some cases, though, delayed puberty is a sign of a medical condition that needs treatment. […] The most common cause of delayed puberty is a harmless gene variant. In other words, delayed puberty runs in the family. Some kids inherit genes that tell their bodies to start puberty a bit later than expected. […] But sometimes, other things can be happening in your childs body that affect when puberty starts or how it progresses. These causes of delayed puberty typically need treatment. […] There are many other possible causes of delayed puberty, including: Addisons disease, Chronic kidney disease, Cystic fibrosis, Genetic disorders, including chromosomal disorders like Turner syndrome and Klinefelter syndrome, Excessive exercise, which can greatly reduce body fat and disrupt hormone function, Growth hormone deficiency, Hypothyroidism, Inflammatory bowel disease, Malnutrition from various causes, including eating disorders, Medications or treatments, including corticosteroids, chemotherapy or radiation therapy, Trauma to your childs brain or sex glands (testes or ovaries), Tumors affecting your childs brain or spinal cord, Type I diabetes.

• #1 Delayed Puberty: Causes and Treatment | Doctor

  https://patient.info/doctor/delayed-puberty

  Psychosocial deprivation. […] Steroid therapy. […] Hypothyroidism. […] Impaired hypothalamo-pituitary axis: […] Tumours adjacent to the hypothalamo-pituitary axis – eg, craniopharyngioma, optic glioma, germinomas, astrocytomas, pituitary tumours (including hyperprolactinaemia). […] Congenital anomalies – eg, septo-optic dysplasia, congenital panhypopituitarism. […] Irradiation treatment. […] Trauma: surgery, head injury. […] Low gonadotrophin and sex steroid levels in the absence of abnormalities in the hypothalamic-pituitary-gonadal system. As well as cryptorchidism, associated features include micropenis, synkinesia (mirror movements), cleft lip and palate, dental agenesis, skeletal anomalies and hearing loss. Many have associated loss of smell – Kallmann’s syndrome.

• #1 Delayed Puberty (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/delayed-puberty.html

  Being malnourished not eating enough food or not getting good nutrients can make someone develop later than peers who eat a healthy, balanced diet. This can happen because of food insecurity, as well as disordered eating or excess physical activity. […] Problems in the pituitary gland or thyroid gland, which make hormones important for body growth and development, also can delay puberty. […] Chromosome disorders can delay puberty in some people. Chromosomes are made up of DNA that contain our body’s construction plans. So when they have problems, it can affect normal growth processes. For example: Turner syndrome is when one of a female’s two X chromosomes is abnormal or missing. This causes problems with how her body grows and makes sex hormones, and how her ovaries develop. […] Klinefelter syndrome is when males are born with an extra X chromosome(XXY instead of XY). This condition can affect testicular function and sexual development. These boys usually are tall for their age, might have learning problems, and may have other medical problems. Puberty usually starts at a normal time, but then stalls.

• #1 Delayed puberty in boys: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/007695.htm

  Delayed puberty in boys is when puberty does not begin by 14 years of age. […] In most cases, delayed puberty is simply a matter of growth changes beginning later than usual, sometimes called late bloomer. Once puberty begins, it progresses normally. This is called constitutional delayed puberty, and it runs in families. This is the most common cause of late maturity. […] Delayed puberty also may occur when the testes produce too little or no male hormones. This is called hypogonadism. […] This can occur when the testes are damaged or are not developing as they should. […] It can also occur if there’s a problem in parts of the brain involved in puberty. […] Certain medical conditions or treatments can lead to hypogonadism: Celiac disease, Inflammatory bowel disease (IBD), Underactive thyroid gland, Diabetes mellitus, Cystic fibrosis, Sickle cell disease, Liver and kidney disease, Anorexia nervosa (uncommon in boys), Autoimmune diseases, such as Hashimoto thyroiditis or Addison disease, Chemotherapy or radiation cancer treatment, A tumor in the pituitary gland, Klinefelter syndrome, a genetic disorder, Absence of testes at birth (anorchia), Injury or trauma to the testicles due to testicular torsion.

• #1 Delayed puberty – Wikipedia

  https://en.wikipedia.org/wiki/Delayed_puberty

  When underweight or sickly children are present with pubertal delay, it is warranted to search for illnesses that cause a temporary and reversible delay in puberty. […] Primary failure of the ovaries or testes (gonads) will cause delayed puberty due to the lack of hormonal response by the final receptors of the HPG axis. […] Congenital diseases include untreated cryptorchidism where the testicles fail to descend from the abdomen. […] Acquired diseases include mumps orchitis, Coxsackievirus B infection, irradiation, chemotherapy, or trauma; all problems causing the gonads to fail. […] The hypothalamic-pituitary-gonadal axis can also be affected at the level of the brain. […] The age of onset of puberty is dependent on genetics, general health, socioeconomic status, and environmental exposures. […] Subnormal vitamin A intake is one of the etiological factors in delayed pubertal maturation.

• #1 Delayed Puberty – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544322/

  Delayed puberty not infrequently occurs in the pediatric population and a common reason for referral to a pediatric endocrinologist. […] This activity reviews the evaluation and management of pubertal delay and highlights the role of interprofessional team members in collaborating to provide well-coordinated care to patients with this condition. […] Identify the etiology of delayed puberty. […] Common causes of delayed puberty for both males and females can be from functional hypogonadotropic hypogonadism – this is normally a temporary clinical state brought on by different stresses to the body, including chronic illnesses such as severe persistent asthma, sickle cell anemia, cystic fibrosis, or ulcerative colitis. […] A rarer cause of hypogonadotropic hypogonadism that is congenital is panhypopituitarism.

• #1 Delayed Puberty – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/hormonal-disorders-in-children/delayed-puberty

  Delayed puberty is defined as absence of the start of sexual maturation at the expected time. […] Sometimes, delayed puberty is caused by chronic medical problems, hormonal disorders, radiation therapy or chemotherapy, disordered eating or excessive exercise, genetic disorders, tumors, and certain infections. […] In the majority of cases, delayed puberty represents a normal variation, which may run in the family (also called constitutional delay of puberty). […] Various disorders, such as poorly controlled diabetes mellitus, inflammatory bowel disease, kidney disease, cystic fibrosis, and anemia, can delay or prevent sexual development. […] Development may be delayed or absent in adolescents receiving radiation therapy or cancer chemotherapy. […] Puberty may also be delayed by autoimmune disorders (such as Hashimoto thyroiditis, Addison disease, and some disorders that directly affect the ovaries).

• #1 Puberty Disorders | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/pediatric-puberty-disorders/

  Delayed puberty usually runs in families or has unknown causes. We call this constitutional delay of growth and puberty. It is often a diagnosis of exclusion, meaning we can find no other cause. […] Some factors can make children more likely to experience early puberty. These include being female, African American or struggling with excess weight. Another factor is exposure to products that contain estrogen or testosterone. […] Low body fat can be a cause of late puberty. This can happen with high athleticism, chronic illness, eating disorders or low appetite from ADHD medication. Sometimes, its due to problems with the ovaries, testicles or brain.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Causes-of-Delayed-Puberty.aspx

  Peripheral causes that may lead to delayed puberty in girls include: Health conditions (e.g. Turner syndrome, Prader-Willi, Bardet-Biedl syndrome, Swyer syndrome, polycystic ovary syndrome), Medications (e.g. cyclophosphamide, busulfan), Radiation therapy directed to the abdominal region, Sexual disorders (e.g. androgen insensitivity syndrome, congenital adrenal hyperplasia), Thalassaemia (overload of iron).

• #1 Delayed Puberty in Girls: Causes and Symptoms

  https://www.massgeneral.org/children/delayed-puberty/girls-causes-symptoms

  Delayed puberty is when your daughter does not show the first signs of gonadal puberty by the time she is 13 years old. […] There are 2 types of delayed puberty, which are: […] Primary hypogonadism. This is when the ovaries do not respond to the hormones FSH and LH made by the pituitary gland. […] Secondary hypogonadism. This is when the pituitary gland does not make the hormones FSH and LH. This type of delayed puberty may happen very late, but is otherwise normal. It also tends to run in families.

• #1 What causes delayed or absent puberty? | Top Doctors

  https://www.topdoctors.co.uk/medical-articles/delayed-puberty-late-bloomer-or-medical-condition

  Hypothalamus and pituitary gland dysfunction while it is rare, delayed or even absent puberty can be caused by a problem within the hypothalamus-pituitary gland; a small central region of the deep mid-brain that controls many vital functions including maturation and reproduction. […] Genetic causes conditions such as Kallmann syndrome can specifically affect the pubertal signalling message. […] Problems with the testes or ovaries in boys, problems affecting the function of the testes such as cryptorchidism (undescended testes), testicular torsion, some cancer therapies and the genetic condition, Klinefelters syndrome can delay puberty or compromise fertility. In girls, the absence of ovarian development, Turner syndrome or premature ovarian insufficiency can cause an absence of puberty or pubertal arrest.

• #1 Delayed Puberty – Girls – Pediatric Endocrine Society

  https://pedsendo.org/patient-resource/delayed-puberty-girls/

  Puberty starts when the pituitary gland begins to produce two hormones, luteinizing hormone (called LH) and follicle-stimulating hormone (called FSH), which cause the ovaries to enlarge and begin producing estrogens. […] Some girls with delayed puberty are simply late maturers, but once they start, puberty will progress normally. This is called constitutional delayed puberty and is more common in boys than girls. Often, this is something that is inherited from the parents, so it is more likely to occur if the mother started her periods after age 14 (the average is about 12 12) or if the father was a late bloomer. […] Decreased body fat is a major cause of pubertal delay in girls. It can be seen in girls who are very athletic, particularly in gymnasts, ballet dancers, and competitive swimmers. It can also be seen in girls with anorexia nervosa, who engage in extreme dieting or binging and purging, because they fear becoming too fat even when they are abnormally thin. Finally, it can be seen in a number of chronic illnesses in which body fat is often decreased.

• #1

  https://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Delayed-Puberty-in-Girls-Information-for-Parents.aspx

  Puberty starts when the pituitary gland begins to produce two hormones, luteinizing hormone (called LH) and follicle-stimulating hormone (called FSH), which cause the ovaries to enlarge and begin producing estrogens. […] What causes puberty in girls to be delayed? […] Decreased body fat is a major cause of pubertal delay in girls. […] Some girls with delayed puberty may have problems with their ovaries. […] The major cause present at birth is Turner syndrome, in which all or part of one of the two X chromosomes is missing. […] The major acquired cause of ovarian insufficiency is damage to the ovaries as a result of radiation, usually to treat leukemia or certain other kinds of cancer. […] Finally, some girls fail to start puberty because of a lack of the pituitary hormones LH and FSH, also called gonadotropins.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Causes-of-Delayed-Puberty.aspx

  There are also several central causes that are not associated with abnormal structure and function of the hypothalamic-pituitary axis. These include: Health conditions (e.g. kidney disease, Crohns disease, cystic fibrosis, hypothyroidism), Medications (e.g. steroid therapy), Malnutrition (e.g. coeliac disease, anorexia nervosa), Excessive physical exertion (e.g. professional athletes and gymnasts), Psychosocial deprivation. […] Peripheral causes that may lead to delayed puberty in boys include: Testicular damage to both sides (e.g. cryptorchidism, unsuccessful orchidopexy, atresia, testicular torsion, mumps or other infections), Health conditions (e.g. Noonans syndrome, Prader-Willi syndrome, Bardet-Beidl syndrome, Klinefelters syndrome, chromosomal disorders), Radiation therapy directed to the testicular or genital region, Medications (e.g. cyclophosphamide).

• #1 Delayed Puberty: Causes and Treatment | Doctor

  https://patient.info/doctor/delayed-puberty

  Boys: […] Bilateral testicular damage: cryptorchidism, failed orchidopexy, atresia, testicular torsion, infection (mumps rarely causes prepubertal damage). […] Syndromes associated with cryptorchidism or gonadal dysgenesis: Noonan’s syndrome, Prader-Willi syndrome, Bardet-Biedl syndrome, Klinefelter’s syndrome, other XY aneuploidy syndromes, XO/XY. […] Irradiation, total or testicular. […] Drugs – eg, cyclophosphamide. […] Girls: […] Gonadal dysgenesis: Turner syndrome, Prader-Willi syndrome, Bardet-Biedl syndrome, Swyer syndrome (45,XY). […] Irradiation, total or abdominal. […] Drugs – eg, cyclophosphamide, busulfan. […] Intersex disorders – eg, complete androgen insensitivity syndrome (primary amenorrhoea may be the presenting symptom), congenital adrenal hyperplasia.

• #1

  https://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Delayed-Puberty.aspx

  Boys can start puberty at a wide range of ages, with 95% starting between the ages of 9 and 14, so we consider puberty delayed when it has not started by age 14. […] By far, the most common cause is constitutional delayed puberty. These boys are generally healthy and will eventually go through puberty if given enough time. In about two thirds of cases, it is inherited from one or both parents. […] A smaller number of boys with delayed puberty have a lifelong deficiency of the puberty hormones LH and FSH, a problem we call isolated gonadotropin deficiency (IGD). […] Failure to start puberty by age 17 is one sign a boy might have IGD. […] Because it is easy to determine the size of the testicles on a physical exam, having very small testicles or testicles that cannot be readily felt is a clue to the condition.

• #1 Timing of puberty: why is it changing and why does it matter? | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/134-winter19/features/timing-of-puberty-why-is-it-changing-and-why-does-it-matter/

  The effect of possible endocrine-disrupting chemicals (EDCs) on the timing of puberty has also been an ongoing concern. […] Despite the importance of environmental factors, a genetic influence on the timing of puberty is fundamental. Although the timing of pubertal onset varies within and between different populations, it is a highly heritable trait, as shown by the high correlation of the timing of sexual maturation within families and in twin studies. […] More than 40 genes have been identified, mutation of which causes or contributes to the aetiology of these conditions. Many of these are specific to isolated delayed puberty, syndromic pubertal delay or hypogonadotrophic hypogonadism. […] Disturbances of puberty encompass an important group of pathologies within the field of paediatric endocrinology, affecting over 4% of adolescents.

• #1 Delayed Puberty/Delayed Sexual Development | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/delayed-puberty-delayed-sexual-development

  Delayed puberty can be caused by an underlying medical condition (e.g., celiac disease or a hormone deficiency). […] There’s often a hereditary component to delayed puberty. If a parent was late in starting puberty, it’s more likely that his or her child might be, too. […] A few different things can cause delayed puberty. […] CGD is often inherited. If one or both parents were “late-bloomers,” it’s likely that their child may be, too. […] These might include: Cardiac conditions, Celiac disease (which affects a child’s ability to gain weight, making it harder to grow at the same rate as his peers), Conditions that prevent the hypothalamus or pituitary gland from sending the “start puberty” signal, Conditions that prevent the ovaries or testes from being able to respond to the “start puberty” signal, Certain genetic conditions, such as Klinefelter’s syndrome in boys and Turner syndrome in girls. […] Some psychiatric medications can contribute to delayed puberty, too.

• #1 Timing of puberty: why is it changing and why does it matter? | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/134-winter19/features/timing-of-puberty-why-is-it-changing-and-why-does-it-matter/

  Puberty is the key developmental stage of transition from childhood to adult life, with the achievement of adult height and body proportions, the development of external sexual characteristics and the capacity to reproduce. […] In some children, puberty may take place prematurely to produce precocious puberty, whilst, in others, it fails to be switched on at the appropriate time, leading to delayed puberty. The mechanisms behind these pubertal timing abnormalities are varied, and many remain incompletely understood. […] Nutritional status, adoption, geographical migration and emotional well-being all have an effect on pubertal timing. Nutritional changes clearly have a key role, as shown by the positive correlation between age at puberty onset and childhood body size, particularly in girls.

• #1 Delayed Puberty | SpringerLink

  https://link.springer.com/10.1007/978-3-319-44441-3_25

  Delayed puberty can be a source of great concern and anxiety, although it usually is caused by a self-limiting variant of the normal physiological timing named constitutional delay of growth and puberty (CDGP). […] The underlying reasons for the large variation in the age at pubertal onset are not fully established; however, nutritional status and socioeconomic and environmental factors are known to be influencing, and a significant amount of influencing genetic factors have also been identified. […] Management of the delayed puberty depends on the etiology. […] The long-term consequences of delayed puberty are both physical (e.g., reduced fertility and decreased bone mineral density) and psychological (e.g., low self-esteem) and underline the importance of careful clinical assessment of the patients.

• #1 Late Puberty: Weighing the Options for KidsCalifornia Consumer Privacy Act (CCPA) Opt-Out Icon

  https://health.usnews.com/health-care/patient-advice/articles/2017-04-12/late-puberty-weighing-the-options-for-kids

  Malnourishment is a surprisingly common cause of delayed puberty in younger high-school children, Zimmerman says, particularly in athletic girls who are extremely active. „They’re expending an enormous number of calories,” he explains, but not eating enough to make up for it. […] „I do a lot of counseling with families,” Stafford says. „My job, first of all, is to determine whether there’s pathology. And whether there’s a problem that we need to deal with that is causing early or delayed puberty.” Taking X-rays of the hand and wrist can help doctors determine the child’s bone age and predict his or her height as an adult. Blood tests pinpoint hormone levels and can narrow down the causes of delayed puberty. […] For families considering treatment for boys with delayed puberty, testosterone therapy is a possibility. Most often, injections are given in low doses for a limited period of several months.

• #2 Delayed Puberty – Girls – Pediatric Endocrine Society

  https://pedsendo.org/patient-resource/delayed-puberty-girls/

  Puberty starts when the pituitary gland begins to produce two hormones, luteinizing hormone (called LH) and follicle-stimulating hormone (called FSH), which cause the ovaries to enlarge and begin producing estrogens. […] Some girls with delayed puberty are simply late maturers, but once they start, puberty will progress normally. This is called constitutional delayed puberty and is more common in boys than girls. Often, this is something that is inherited from the parents, so it is more likely to occur if the mother started her periods after age 14 (the average is about 12 12) or if the father was a late bloomer. […] Decreased body fat is a major cause of pubertal delay in girls. It can be seen in girls who are very athletic, particularly in gymnasts, ballet dancers, and competitive swimmers. It can also be seen in girls with anorexia nervosa, who engage in extreme dieting or binging and purging, because they fear becoming too fat even when they are abnormally thin. Finally, it can be seen in a number of chronic illnesses in which body fat is often decreased.

• #2 Early or Delayed Puberty | Midwest Pediatric Specialists

  https://www.midwestpediatricspecialists.com/early-of-delayed-puberty/

  Early puberty, also known as precocious puberty, refers to the early onset of puberty before the age of 8 in girls and 9 in boys. The causes of early puberty can vary and may include genetic factors, certain medical conditions, hormonal imbalances, or exposure to environmental factors such as chemicals or toxins. […] Delayed puberty can be caused by a variety of factors, including constitutional delay, which is a familial pattern of late maturation, chronic illnesses, hormonal imbalances, malnutrition, excessive exercise, or emotional stress.

• #2 Precocious puberty – Wikipedia

  https://en.wikipedia.org/wiki/Precocious_puberty

  In medicine, precocious puberty is puberty occurring at an unusually early age. In most cases, the process is normal in every aspect except the unusually early age and simply represents a variation of normal development. […] In a minority of children with precocious puberty, the early development is triggered by a disease such as a tumor or injury of the brain. […] Causes of central precocious puberty can include: hypothalamic hamartoma produces pulsatile gonadotropin-releasing hormone (GnRH), Langerhans cell histiocytosis, McCune-Albright syndrome. […] Central precocious puberty can also be caused by brain tumors, infection (most commonly tuberculous meningitis, especially in developing countries), trauma, hydrocephalus, and Angelman syndrome. […] If no cause can be identified, it is considered idiopathic or constitutional.

• #2 What causes delayed or precocious puberty?

  https://www.markvanderpump.co.uk/blog/posts/puberty-and-hormones-

  What causes delayed or precocious puberty? […] it is not known why this should be the case, theories have been expounded around better health; a higher BMI; a diet with increased sugar and fat; declining physical activity or chemicals in the environment that act on hormones but there no set conclusions. […] 90% of cases occur in children who are perfectly healthy but simply have a slower rate of development. Typically these children are shorter and thinner than their peers and have a family history of delayed puberty. […] In 90% of girls and 50% of boys no underlying cause can be identified which means it is referred to as idiopathic precocious puberty. […] If this is not occurring in children who generally have a slow rate of development doctors will check that this is not: […] caused by a tumour, trauma, surgery or radiation therapy to the head.

• #2 Early or delayed puberty

  https://www2.hse.ie/conditions/early-or-delayed-puberty/

  There’s usually no need to worry if puberty does not start around the average age. But in some cases, early or delayed puberty could be a sign of an underlying condition that may need treatment. […] Early puberty is also called precocious puberty. […] It’s not always clear what causes early puberty. It may be something that runs in your family. […] Sometimes the cause can be: a problem with your child’s organs, such as their ovaries or thyroid gland; damage to your child’s brain as a result of an infection, surgery or radiotherapy; a genetic disorder, such as McCune-Albright syndrome; a problem in your child’s brain, such as a tumour. […] It’s not always clear what causes delayed puberty. It may be something that runs in your family. […] Sometimes the cause can be: a long-term illness, such as cystic fibrosis, kidney disease or diabetes; malnutrition, from a condition such as coeliac disease or an eating disorder; a problem with your child’s ovaries, testes, thyroid gland or pituitary gland; differences in sex development, such as androgen insensitivity syndrome; a genetic condition, such as Kallmann syndrome and Klinefelter syndrome.

• #2 Timing of puberty: why is it changing and why does it matter? | Society for Endocrinology

  https://www.endocrinology.org/endocrinologist/134-winter19/features/timing-of-puberty-why-is-it-changing-and-why-does-it-matter/

  The effect of possible endocrine-disrupting chemicals (EDCs) on the timing of puberty has also been an ongoing concern. […] Despite the importance of environmental factors, a genetic influence on the timing of puberty is fundamental. Although the timing of pubertal onset varies within and between different populations, it is a highly heritable trait, as shown by the high correlation of the timing of sexual maturation within families and in twin studies. […] More than 40 genes have been identified, mutation of which causes or contributes to the aetiology of these conditions. Many of these are specific to isolated delayed puberty, syndromic pubertal delay or hypogonadotrophic hypogonadism. […] Disturbances of puberty encompass an important group of pathologies within the field of paediatric endocrinology, affecting over 4% of adolescents.

• #2 Precocious puberty – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/precocious-puberty/symptoms-causes/syc-20351811

  Precocious puberty is when children’s bodies begin to change into adult bodies too soon. […] The cause of precocious puberty often can’t be found. Rarely, certain conditions, such as infections, hormone issues, tumors, brain issues or injuries, may cause precocious puberty. […] The cause of this type of precocious puberty often isn’t known. […] In rare cases, the following can cause central precocious puberty: A tumor in the brain or spinal cord. A change in the brain that’s present at birth. This could be fluid buildup, known as hydrocephalus, or a tumor that isn’t cancer, known as a hamartoma. Radiation to the brain or spinal cord. Injury to the brain or spinal cord. A rare genetic disease that affects bones and skin color and causes hormonal problems. This condition is called McCune-Albright syndrome. A group of genetic issues, called congenital adrenal hyperplasia, that involve the adrenal gland making atypical hormones. A condition called hypothyroidism in which the thyroid gland doesn’t make enough hormones.

• #2 Puberty – TeachMePaediatrics

  https://teachmepaediatrics.com/endocrinology/adrenal-glands/puberty/

  Early-Onset (Precocious) Puberty: In girls, this is usually idiopathic and familial. In boys, you should have a high suspicion for underlying pathology such as a tumour or trauma. Precocious puberty may be classed as either true or false: […] True precocious puberty- due to early activation of the Hypothalamic-Pituitary axis. […] False precocious puberty- gonadotrophin independent. Usually presents with the isolated development of one pubertal characteristic. […] Causes of true gonadotrophin dependent precocious puberty: Central malformation or damage e.g. hydrocephalus, neurofibromatosis; Acquired- post-sepsis, surgery, radiotherapy, trauma, birth anoxia; Brain tumours. […] Causes of false gonadotrophin-dependent precocious puberty: Increased adrenal activity- congenital adrenal hyperplasia; Exogenous sex steroids; Gonadal tumour- ovarian/testicular tumours; Hypothyroidism; McCune Albright syndrome- polyostotic fibrous dysplasia.

• #2 Precocious puberty – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/precocious-puberty/symptoms-causes/syc-20351811

  Estrogen or testosterone being made too soon causes this type of precocious puberty. […] A problem with the ovaries, testicles, adrenal glands or pituitary gland causes the hormone release. […] The following can lead to peripheral precocious puberty: A tumor in the adrenal glands or in the pituitary gland that releases estrogen or testosterone. A rare genetic disease that affects bones and skin color and causes hormonal problems. This condition is called McCune-Albright syndrome. Being exposed to creams or ointments that contain estrogen or testosterone.

• #2 Precocious puberty – Wikipedia

  https://en.wikipedia.org/wiki/Precocious_puberty

  Secondary sexual development induced by sex steroids from other abnormal sources is referred to as peripheral precocious puberty or precocious pseudopuberty. […] Causes can include: Endogenous sources such as gonadal tumors (such as arrhenoblastoma), adrenal tumors, germ cell tumor, congenital adrenal hyperplasia, McCune-Albright syndrome, Silver-Russell syndrome, familial male-limited precocious puberty (testotoxicosis). […] Although the causes of early puberty are still somewhat unclear, girls who have a high-fat diet and are not physically active or are obese are more likely to physically mature earlier. […] In addition to diet and exercise habits, exposure to chemicals that mimic estrogen (known as xenoestrogens) is another possible cause of early puberty in girls. […] Familial cases of idiopathic central precocious puberty (ICPP) have been reported, leading researchers to believe there are specific genetic modulators of ICPP. […] The gene MKRN3, which is a maternally imprinted gene, was first cloned by Jong et al. in 1999. MKRN3 has since been identified as a cause of premature sexual development or CPP.

• #2 Approach to the patient with delayed puberty – UpToDate

  https://www.uptodate.com/contents/approach-to-the-patient-with-delayed-puberty

  Delayed puberty is defined clinically as the absence of the first signs of pubertal development beyond the normal range for the population. […] The most common cause of delayed puberty is a functional delay in production of gonadotropin-releasing hormone (GnRH) from the hypothalamic neuronal networks that initiate the episodic or pulsatile release of the GnRH and activate the hypothalamic-pituitary-gonadal axis. […] Other causes of delayed puberty include a variety of hypothalamic, pituitary, and gonadal disorders.

• #2 Delayed puberty | Endocrine Conditions

  https://www.yourhormones.info/endocrine-conditions/delayed-puberty/

  Delayed puberty is defined as no secondary sexual maturation or any sign of puberty by the age of 13 years in girls and 14 years in boys. […] The most common cause of delayed puberty is constitutional delay of growth and puberty, which is sometimes referred to as CDGP. […] In over 90% of cases, delayed puberty is due to what is known as a constitutional delay in growth and puberty. This means it occurs in children who are healthy but simply have a slower rate of physical development than average. […] Sometimes delayed puberty and growth can be secondary to a chronic illness, malnutrition, excessive physical exercise and even stress. […] Rare causes of delayed or absent puberty can be caused by loss of hormone secretion from the hypothalamus and pituitary gland or by disorders of the testes or ovaries.

• #2 What causes normal puberty, precocious puberty, & delayed puberty? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  https://www.nichd.nih.gov/health/topics/puberty/conditioninfo/causes

  Secondary hypogonadism (also known as central hypogonadism or hypogonadotropic hypogonadism), is caused by a problem with the pituitary gland or hypothalamus (part of the brain). In secondary hypogonadism, the hypothalamus and the pituitary gland fail to signal the gonads to properly release sex hormones. Causes of secondary hypogonadism include: Kallmann syndrome, a genetic problem that also diminishes the sense of smell. […] In primary hypogonadism, the problem lies in the ovaries or testes, which fail to make sex hormones normally. Some causes include genetic disorders, especially Turner syndrome (in women) and Klinefelter syndrome (in men).

• #2 Delayed Puberty – Zero To Finals

  https://zerotofinals.com/paediatrics/development/delayedpuberty/

  Hypogonadism refers to a lack of the sex hormones, oestrogen and testosterone, that normally rise prior to and during puberty. A lack of these hormones causes a delay in puberty. This is fundamentally due to one of two reasons: […] A deficiency of LH and FSH is the result of abnormal functioning of the hypothalamus or pituitary gland. This could be due to: […] Hypergonadotropic hypogonadism is where the gonads fail to respond to stimulation from the gonadotrophins (LH and FSH). There is no negative feedback from the sex hormones (testosterone and oestrogen), therefore the anterior pituitary produces increasing amounts of LH and FSH to try harder to stimulate the gonads. […] Hypergonadotropic hypogonadism is the result of abnormal functioning of the gonads. This could be due to: […] Kallman syndrome is a genetic condition causing hypogonadotrophic hypogonadism, resulting in failure to start puberty.

• #2 Delayed Puberty: Causes and Treatment | Doctor

  https://patient.info/doctor/delayed-puberty

  Psychosocial deprivation. […] Steroid therapy. […] Hypothyroidism. […] Impaired hypothalamo-pituitary axis: […] Tumours adjacent to the hypothalamo-pituitary axis – eg, craniopharyngioma, optic glioma, germinomas, astrocytomas, pituitary tumours (including hyperprolactinaemia). […] Congenital anomalies – eg, septo-optic dysplasia, congenital panhypopituitarism. […] Irradiation treatment. […] Trauma: surgery, head injury. […] Low gonadotrophin and sex steroid levels in the absence of abnormalities in the hypothalamic-pituitary-gonadal system. As well as cryptorchidism, associated features include micropenis, synkinesia (mirror movements), cleft lip and palate, dental agenesis, skeletal anomalies and hearing loss. Many have associated loss of smell – Kallmann’s syndrome.

• #2 Delayed puberty | Endocrine Conditions

  https://www.yourhormones.info/endocrine-conditions/delayed-puberty/

  Disorders of the testes or ovaries can cause hypergonadotrophic delayed puberty. […] Chromosomal disorders such as Klinefelters syndrome in boys and Turner syndrome in girls result in abnormal development of the testes and ovaries with reduced or absent production of testosterone or oestrogen. […] The exact cause of the delayed puberty is more difficult to diagnose. […] Hormonal treatment is usually reserved for true cases of gonadotrophin deficiency (hypogonadotrophic hypogonadism) and failure of the testes or ovaries such as in Klinefelters syndrome, Turner syndrome or any permanent damage to the testes or ovaries.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Causes-of-Delayed-Puberty.aspx

  There are also several central causes that are not associated with abnormal structure and function of the hypothalamic-pituitary axis. These include: Health conditions (e.g. kidney disease, Crohns disease, cystic fibrosis, hypothyroidism), Medications (e.g. steroid therapy), Malnutrition (e.g. coeliac disease, anorexia nervosa), Excessive physical exertion (e.g. professional athletes and gymnasts), Psychosocial deprivation. […] Peripheral causes that may lead to delayed puberty in boys include: Testicular damage to both sides (e.g. cryptorchidism, unsuccessful orchidopexy, atresia, testicular torsion, mumps or other infections), Health conditions (e.g. Noonans syndrome, Prader-Willi syndrome, Bardet-Beidl syndrome, Klinefelters syndrome, chromosomal disorders), Radiation therapy directed to the testicular or genital region, Medications (e.g. cyclophosphamide).

• #2

  https://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Delayed-Puberty.aspx

  There are several causes, including previous surgery for undescended testicles or cancer treatments, which can injure the testicles. […] For constitutional delayed puberty, the problem will resolve with waiting and reassurance. However, late-maturing boys are often impatient to start growing and do not want to wait another 6-18 months for the pubertal growth spurt to start naturally. […] When the problem is either IGD or damage to the testicles, testosterone is still the treatment of choice, but the dose will need to be increased over time and it will need to be continued well into the adult years.

• #2 Delayed Puberty – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/hormonal-disorders-in-children/delayed-puberty

  Delayed puberty is defined as absence of the start of sexual maturation at the expected time. […] Sometimes, delayed puberty is caused by chronic medical problems, hormonal disorders, radiation therapy or chemotherapy, disordered eating or excessive exercise, genetic disorders, tumors, and certain infections. […] In the majority of cases, delayed puberty represents a normal variation, which may run in the family (also called constitutional delay of puberty). […] Various disorders, such as poorly controlled diabetes mellitus, inflammatory bowel disease, kidney disease, cystic fibrosis, and anemia, can delay or prevent sexual development. […] Development may be delayed or absent in adolescents receiving radiation therapy or cancer chemotherapy. […] Puberty may also be delayed by autoimmune disorders (such as Hashimoto thyroiditis, Addison disease, and some disorders that directly affect the ovaries).

• #2 Delayed Puberty – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/hormonal-disorders-in-children/delayed-puberty

  A tumor that damages the pituitary gland or the hypothalamus can lower the levels of gonadotropins or stop production of the hormones altogether. […] In boys, delayed puberty may be caused by decreased production of testosterone, sperm, or both (hypogonadism). […] Adolescents who become very thin because of undernutrition or an eating disorder often have delayed puberty. […] Excessive exercise may cause delayed puberty, especially in girls, who may have no menstrual periods (amenorrhea). […] Chromosome abnormalities, such as Turner syndrome in girls and Klinefelter syndrome in boys, and other genetic disorders can affect the production of sex hormones. […] Some children are normal but simply do not start puberty at the usual age, a phenomenon called constitutional delay of puberty. […] Constitutional delay is not caused by hormonal or genetic problems or an underlying disorder (such as inflammatory bowel disease or eating disorders), but doctors may evaluate children to rule out other causes of short stature and delayed puberty.

• #2 Delayed Puberty: Signs, Causes & Treatment Explained – BuzzRx

  https://www.buzzrx.com/blog/delayed-puberty

  Delayed puberty can result from genetic factors (Turner syndrome), medical conditions (diabetes, thyroid disorders), lifestyle factors (excessive exercise), malnutrition, or medical treatments like chemotherapy. […] Chronic disorders can be responsible for delaying puberty. For example: Nutritional deficiencies such as anemia, poorly controlled diabetes mellitus, inflammatory bowel disease (IBD), celiac disease, liver disease, kidney disease, thyroid disorders, autoimmune disorders such as Hashimotos thyroiditis, Addison disease, cystic fibrosis, hypopituitarism (underactive pituitary gland), tumors of the hypothalamus or pituitary gland, hemochromatosis (excess iron in the body), certain infections, an eating disorder such as anorexia nervosa, rapid and significant weight loss, for example, from bariatric surgery.

• #2 Delayed Puberty/Delayed Sexual Development | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/delayed-puberty-delayed-sexual-development

  Delayed puberty can be caused by an underlying medical condition (e.g., celiac disease or a hormone deficiency). […] There’s often a hereditary component to delayed puberty. If a parent was late in starting puberty, it’s more likely that his or her child might be, too. […] A few different things can cause delayed puberty. […] CGD is often inherited. If one or both parents were “late-bloomers,” it’s likely that their child may be, too. […] These might include: Cardiac conditions, Celiac disease (which affects a child’s ability to gain weight, making it harder to grow at the same rate as his peers), Conditions that prevent the hypothalamus or pituitary gland from sending the “start puberty” signal, Conditions that prevent the ovaries or testes from being able to respond to the “start puberty” signal, Certain genetic conditions, such as Klinefelter’s syndrome in boys and Turner syndrome in girls. […] Some psychiatric medications can contribute to delayed puberty, too.

• #2 Early or delayed puberty | nidirect

  https://www.nidirect.gov.uk/conditions/early-or-delayed-puberty

  Early puberty, also called precocious puberty, is when: […] It’s not always clear what causes early puberty. It may just be a tendency that runs in your family. […] Occasionally it can be caused by: a problem in the brain, such as a tumour; damage to the brain as a result of an infection, surgery or radiotherapy; a problem with the ovaries or thyroid gland; a genetic disorder, such as McCune-Albright syndrome. […] Early puberty mostly affects girls and often has no obvious cause. […] It’s less common in boys and may be more likely to be associated with an underlying problem. […] Delayed puberty is when: […] It’s not always clear what causes delayed puberty. It may just be a tendency that runs in your family, and is generally more common in boys. […] Occasionally it can be caused by: a long-term illness, such as cystic fibrosis, diabetes or kidney disease; malnutrition, possibly from an eating disorder or a condition such as cystic fibrosis or coeliac disease; a problem with the ovaries, testes, thyroid gland, or a gland in the brain called the pituitary gland; a disorder of sexual development, such as androgen insensitivity syndrome; a genetic condition, such as Kallman syndrome and Klinefelter syndrome.

• #2 Delayed Puberty – Girls – Pediatric Endocrine Society

  https://pedsendo.org/patient-resource/delayed-puberty-girls/

  Some girls with delayed puberty may have problems with their ovaries. The ovaries are either not developing properly or are being damaged. This is referred to as primary ovarian insufficiency. The major cause present at birth is Turner syndrome, in which all or part of one of the two X chromosomes is missing. […] Finally, some girls fail to start puberty because of a lack of the pituitary hormones LH and FSH, also called gonadotropins. This can occur when there are other pituitary deficiencies as well, including growth hormone, or it can be an isolated finding (particularly in a girl who is delayed but not short).

• #2 Delayed Puberty: Causes and Treatment | Doctor

  https://patient.info/doctor/delayed-puberty

  Boys: […] Bilateral testicular damage: cryptorchidism, failed orchidopexy, atresia, testicular torsion, infection (mumps rarely causes prepubertal damage). […] Syndromes associated with cryptorchidism or gonadal dysgenesis: Noonan’s syndrome, Prader-Willi syndrome, Bardet-Biedl syndrome, Klinefelter’s syndrome, other XY aneuploidy syndromes, XO/XY. […] Irradiation, total or testicular. […] Drugs – eg, cyclophosphamide. […] Girls: […] Gonadal dysgenesis: Turner syndrome, Prader-Willi syndrome, Bardet-Biedl syndrome, Swyer syndrome (45,XY). […] Irradiation, total or abdominal. […] Drugs – eg, cyclophosphamide, busulfan. […] Intersex disorders – eg, complete androgen insensitivity syndrome (primary amenorrhoea may be the presenting symptom), congenital adrenal hyperplasia.

• #2 Puberty – TeachMePaediatrics

  https://teachmepaediatrics.com/endocrinology/adrenal-glands/puberty/

  Consequences of early puberty: Short stature: early onset of puberty means a child loses 2-3 yrs of typical growth hormone-dependent growth (20cm in females and 30 cm in males); Psychological disturbance: child treated as older than their age, deprived of their childhood; Early menarche: particularly a practical consideration with onset in primary school-age children where the school isn’t set up for it; Safeguarding concerns of early development, particularly in vulnerable special educational needs children. […] Late-Onset Puberty: Diagnosis of late-onset puberty is made if there are no signs seen by the age of 13 in boys and 13 in girls. It can also be diagnosed in girls who have not had their first menstrual period by the age of 16. There are a variety of causes of delayed puberty. Causes of delayed puberty in both sexes are: Maturational delay- commonly runs in families; Gonadal failure- hypogonadotropic hypogonadism (high LH and FSH); Hypothalamic Pituitary dysfunction (hypogonadotropic hypogonadism (low FSH and LH); Chronic and severe disease; Chemo/radiotherapy; Metabolic: Glycogen storage disorders, galactosaemia. […] Some causes of delayed puberty only seen in girls are: Turners Syndrome- the absence of one of the X chromosomes; Anorexia Nervosa; Low body weight/athletic lifestyle; Autoimmune failure- premature ovarian failure.

• #2 Delayed Puberty – Boys – Pediatric Endocrine Society

  https://pedsendo.org/patient-resource/delayed-puberty-boys/

  Boys can start puberty at a wide range of ages, with 95% starting between the ages of 9 and 14, so we consider puberty delayed when it has not started by age 14. […] By far, the most common cause is constitutional delayed puberty. These boys are generally healthy and will eventually go through puberty if given enough time. In about two thirds of cases, it is inherited from one or both parents. […] A smaller number of boys with delayed puberty have a life-long deficiency of the puberty hormones LH and FSH, a problem we call isolated gonadotropin deficiency (IGD). […] Finally, a few boys with delayed puberty have a problem with the testicles themselves. […] There are several causes, including previous surgery for undescended testicles or cancer treatments, which can injure the testicles.

• #2 Delayed puberty in boys: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/007695.htm

  Delayed puberty in boys is when puberty does not begin by 14 years of age. […] In most cases, delayed puberty is simply a matter of growth changes beginning later than usual, sometimes called late bloomer. Once puberty begins, it progresses normally. This is called constitutional delayed puberty, and it runs in families. This is the most common cause of late maturity. […] Delayed puberty also may occur when the testes produce too little or no male hormones. This is called hypogonadism. […] This can occur when the testes are damaged or are not developing as they should. […] It can also occur if there’s a problem in parts of the brain involved in puberty. […] Certain medical conditions or treatments can lead to hypogonadism: Celiac disease, Inflammatory bowel disease (IBD), Underactive thyroid gland, Diabetes mellitus, Cystic fibrosis, Sickle cell disease, Liver and kidney disease, Anorexia nervosa (uncommon in boys), Autoimmune diseases, such as Hashimoto thyroiditis or Addison disease, Chemotherapy or radiation cancer treatment, A tumor in the pituitary gland, Klinefelter syndrome, a genetic disorder, Absence of testes at birth (anorchia), Injury or trauma to the testicles due to testicular torsion.

• #2 Delayed puberty : etiology, outcome and interactions with growth

  https://helda.helsinki.fi/items/7bc4a0d6-4bd1-4b02-bb18-bfd03b15bcb6

  During puberty, adolescents achieve reproductive capability and attain adult height. An intact hypothalamic-pituitary-gonadal (HPG) axis is crucial for the normal onset of puberty. Pubertal timing is influenced by genetic and environmental factors, but the exact mechanisms that trigger puberty remain elusive. A finding of a paternally-inherited loss-of-function mutation in makorin ring finger protein 3 (MKRN3) gene in patients who were diagnosed with central precocious puberty suggests that key genes regulate the central restrain on the HPG axis during childhood, and that the loosening of the restrain precedes the onset of puberty. […] A variety of diseases can delay puberty, but it is particularly important to early identify the patients who suffer from acquired or congenital hypogonadotropic hypogonadism (CHH) which results from the absent or impaired functions of gonadotropin-releasing hormone. This congenital sex steroid deficiency predisposes to long-term consequences, but very little is known about its role in the modulation of growth during early infancy and its impact on health-related quality of life (HRQoL) in adulthood. […] Many diseases can delay pubertal maturation, but CDGP is the most common cause in Finland. In men, the timely diagnosis of CHH is crucial to avoid the long-term adverse effects of sex steroid deficiency on HRQoL.

• #2

  https://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Delayed-Puberty.aspx

  Boys can start puberty at a wide range of ages, with 95% starting between the ages of 9 and 14, so we consider puberty delayed when it has not started by age 14. […] By far, the most common cause is constitutional delayed puberty. These boys are generally healthy and will eventually go through puberty if given enough time. In about two thirds of cases, it is inherited from one or both parents. […] A smaller number of boys with delayed puberty have a lifelong deficiency of the puberty hormones LH and FSH, a problem we call isolated gonadotropin deficiency (IGD). […] Failure to start puberty by age 17 is one sign a boy might have IGD. […] Because it is easy to determine the size of the testicles on a physical exam, having very small testicles or testicles that cannot be readily felt is a clue to the condition.

• #2 Precocious Puberty – Early Puberty: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/21064-precocious-early-puberty

  In the United States, it may seem like more and more girls are hitting puberty early. This trend may be related to the increasing rate of obesity in the country. Researchers link a higher body mass index (BMI) to early breast development. Eating a lot of processed, high-fat foods may cause early puberty. […] Race and ethnicity also play a part in the early timing of puberty. Black and Hispanic female children typically begin puberty earlier than other ethnic groups. Because obesity typically affects these groups more prevalently, this may add to the increase in cases of early puberty.

• #2 Delayed Puberty | SpringerLink

  https://link.springer.com/10.1007/978-3-319-44441-3_25

  Delayed puberty can be a source of great concern and anxiety, although it usually is caused by a self-limiting variant of the normal physiological timing named constitutional delay of growth and puberty (CDGP). […] The underlying reasons for the large variation in the age at pubertal onset are not fully established; however, nutritional status and socioeconomic and environmental factors are known to be influencing, and a significant amount of influencing genetic factors have also been identified. […] Management of the delayed puberty depends on the etiology. […] The long-term consequences of delayed puberty are both physical (e.g., reduced fertility and decreased bone mineral density) and psychological (e.g., low self-esteem) and underline the importance of careful clinical assessment of the patients.

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