The Smallest Kid in School: Evaluating Delayed Puberty

Peter A. Lee, MD, PhD; Christopher P. Houk, MD


August 13, 2012


Delayed puberty is failure to begin pubertal development by age 14 years in boys or breast development by age 13 years or menarche by age 15 years in girls. Although constitutional growth delay is the most common etiology in both boys and girls, careful assessment is needed, particularly in girls, to identify children with temporal pubertal delay who have such underlying conditions as hypergonadotropic hypogonadism and permanent hypogonadotropic hypogonadism.

Regardless of the cause of delayed puberty, therapy with sex steroids results in physical maturity. However, potential fertility using current assisted fertility techniques depends largely on the presence of germ cells in the gonads. As illustrated by the case report, a severely affected hypogonadotropic patient can have a satisfying, well-adjusted adult life.