Puberty is the time for transformation in many ways, both qualitative as well as quantitative. Changes occur in every aspect of the adolescent’s life. Bodily changes in girls may lead to development of breast, pubic and axillary hair and onset of menses (menarche) and spurt in height. In males it is marked with growth of facial hair, pubic hair, change of voice, spurt in height, growth of testes and penis.
Some children may fail this normal spurt of growth as well as the secondary sexual characteristic at an average age, which in girls is 13 years and 14 years in boys.This delay is defined as delayed puberty. In majority of boys and girls delayed puberty is due to constitutional problems, eventually these children undergo puberty by the age of 16 or even later. Nevertheless in some it may be due to chronic disease or hormone deficiency, genetic disorder, strenuous exercise, tumor in brain, etc.
The typical symptoms of delayed puberty include lack of breast growth and onset of menses in girls. In boys there is retarded growth of testes. Treatment will depend on the underlying cause. In constitutional delay the body clock has slowed down hence it does not require any treatment.However, other causes may need hormone replacement therapy and other appropriate treatment.
What Are The Causes Of Delayed Puberty?
Puberty occurs due to interaction between the hypothalamus, anterior pituitary gland in brain and the gonads (ovary or testes). The simple etiopathogenesis of puberty is; hypothalamus secrets a chemical called gonadotropin releasing hormone. It stimulates the pituitary gland in brain to release gonadotropin hormone. The gonadotropin hormone then stimulates growth of ovaries in girls and testes in boys. The growing ovaries will start secreting sex hormones called estrogen in females and testosterone in males.
These hormones trigger development of secondary sexual characteristic such as breast enlargement, pubic hair growth and onset of menses in females. In males it causes growth of facial hair, pubic hair, change of voice, and increase in muscle mass. It causes increase of libido in both genders. Delayed puberty can occur due to two causes; constitutional delay or medical causes.
Constitutional cause: In majority of cases the cause is constitutional. It is a variant of normal puberty and not something abnormal. There is a history of puberty delay in parents or siblings. In such boys and girls the rate of weight growth is normal, but the growth of height may be delayed and is below average. The epiphyseal fusion of bone is late. Eventually over a period of time, these individuals attain normal growth of puberty.
Medical reasons: There are several medical causes that may cause delayed puberty:
- A tumor in brain.
- Head injury or brain surgery in childhood.
- Diabetes, chronic kidney failure, celiac disease, hypothyroidism, cystic fibrosis, rheumatoid arthritis, anemia, Addison’s disease can delay puberty.
- Adolescents receiving chemotherapy or radiation for cancer treatment.
- Patient on steroid therapy for long time.
- Strenuous physical exercise or excessive dieting.
- Damage to testes caused due to infection, trauma, etc.
- Genetic conditions such as Noonan’s syndrome, Kallman syndrome, Klinefelter’s syndrome in boys.
- Radiation in genital region.
Signs And Symptoms Of Delayed Puberty
Delay in puberty can lead to certain symptoms both physical as well as emotional.
- In boys there is lack of growth of secondary sexual characteristics by the age of 14 years. This includes facial hair, enlargement of testes, change of voice, spurt in height and muscle growth.
- In girls there is lack of growth of breast, absence of menses by the age of 13 years. Lack of growth of other secondary sexual characteristic such as pubic and axillary hair. Absence of menses even at the age of 16.
- Boys and girls may have low self esteem because sometimes they may have to bear teasing from their peers. Often these individuals are known to be emotionally disturbed.
Treatment For Delayed Puberty
Treatment of delayed puberty may depend on the underlying cause. If the delay is due to constitutional problem, no treatment is needed. Over a period of time the boy or girl will develop all the features of normal puberty. However, sometimes counseling or hormone therapy may be necessary to begin the process soon. Such treatment is more common in boys as compared to girls.
Low dose testosterone may trigger muscle mass and other secondary sexual characteristic in boys if he does not attain normal puberty symptoms by the age of 14. However, low dose testosterone does not prevent the boy in attaining his normal height. Girls may be started with low dose estrogen hormone skin patch. If delayed puberty is caused due to genetic reasons addressing the cause is important. If the cause is tumor, it needs to be removed surgically.