INVESTIGATION OF DELAYED PUBERTY

Delayed puberty is defined arbitrarily on the basis of statistical con sideration, when no signs of puberty have occurred at 2.0 SD (13.4 yea rs in girls and 13.8 in boys) above the mean chronological age for the onset of puberty. The vast majority of these patients have no endocri ne abnormality and their pubertal development and growth spurt are sim ply consequences of primary delay (constitutional delay of growth and puberty (CDGP)) or secondary delay due to a chronic disease of childho od, such as asthma. However, a small proportion may have pathological causes of delayed puberty which must be careful identified as specific management may be required. Associated with delayed puberty, the grow th spurt is always delayed which is why the condition is described as delayed growth and puberty. Short stature and lack of sexual developme nt may lead to emotional and social difficulties and in some patients their consequences can persist when 'normal' height and full sexual ma turation are attained. Recent data also suggest that a delay in the 't empo' of pubertal maturation may interfere with the normal bone accret ion occurring during puberty, later causing osteoporosis. Such finding s suggest that a new approach in delayed puberty may be necessary not only for psychological reasons but also for optimizing bone mass accre tion.