Delayed puberty in the female patient

The purpose is to review current recommendations for the evaluation and management of delayed puberty in the female patient.

Kisspeptin activation has emerged as an important factor for initiation of pubertal development. Causes of delayed puberty can be considered in four main categories: constitutional delay of growth and puberty, hypergonadotropic hypogonadism, permanent hypogonadotropic hypogonadism, and transient/functional hypogonadism. The most common cause of delayed puberty is constitutional delay of growth and puberty; however, consistent differentiation from idiopathic hypogonadotropic hypogonadism remains challenging. Initial assessment with broad spectrum testing in an otherwise healthy adolescent is often of low clinical value. Treatment is aimed at the underlying cause of delayed puberty whenever possible and individualized to the patient.

Understanding the factors that contribute to delayed puberty and a thoughtful evaluation, structured to the patient, is important to identify the cause of delayed puberty and prevent unnecessary and often expensive investigations. Insuring appropriate pubertal progression, optimizing height and bone health, as well as preservation of psychosocial well-being are the ultimate goals of management of delayed puberty.