Delayed puberty describes a condition in youth who fail to demonstrate signs of sexual development by a certain chronologic age. As with any developmental characteristic that occurs along a spectrum,suspicion for “potential pathology”is set arbitrarily. Age of puberty may be affected by both physiologic and socioeconomic factors and can vary widely. Delayed puberty is present when no signs of sexual maturity (Sexual Maturity Rating Stage I) are apparent. In the United States, most authors use a cutoff of 2 standard deviations from the mean with corresponding ages of 13 years in girls and 14 years in boys. Using these criteria, 2.5% of the normal population will be classified as“delayed.” Once the child’s chronologic age surpasses the age standard,the physician’s job becomes to determine whether delayed puberty is based on constitutional factors or an underlying organic disease.

Because the list of diseases that can cause delayed puberty is long,the clinician must...

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