Precocious or Late Puberty
Precocious Puberty
Causes:
Gonadoptrophin dependent precocious puberty (due to premature activation of the hypothalamo-pituitary- gonadal axis) may be caused by abnormalities of central nervous system including hCG secreting germ cell tumours, CNS trauma or injury, hydrocephalus and hamartomas of hypothalamus.
Gonadotrophin independent precocious puberty accounts for 20% cases and includes Congenital Adrenal Hyperplasia and some rare syndromes.
Refer:
Any Girl who is showing secondary sexual characteristics before 8 years of age
Any Boy who is showing secondary sexual characteristics before 9 years of age
Delayed Puberty
Causes:
- Constitutional (familial) delay is the most common cause in both boys and girls
- Chronic illness eg kidney disease, IBD
- Malnutrition eg anorexia, cystic fibrosis, coeliac disease
- Excessive physical exercise eg. Athletes, gymnasts
- Psychosocial deprivation
- Drugs eg. Steroid therapy, cyclophosphamide
- Hypothyroidism
- Impaired Hypothalamo-pituitary axis eg. Tumours, irradiation treatment, trauma, surgery
- Syndromes: Turner’s, Prader-Willi, Noonan’s, Bardet-Biedl, Kleinefelter’s
Refer to Paediatrics:
Any Girl who is not showing any secondary sexual characteristics, particularly breast development, by 13 years of age
Any Boy who is not showing any secondary sexual characteristics by 14 years of age
NB. Girls with normal secondary sexual characteristics who have not started menstruating by 15 years of age should be referred to the Paediatric and Adolescent Gynaecology Clinic
Child BMI Calculator available here - https://www.healthforallchildren.com/parents-page/bmi/
References: BMJ Best Practice https://bestpractice.bmj.com/topics/en-gb/1127 and 1126
BMJ 2020;368:l6597 (Tanner Stages Picture)
Patient.co.uk article Normal and Abnormal Puberty https://patient.info/doctor/normal-and-abnormal-puberty
Date: July 2021
Review Date: July 2022
Author: Dr S Burns GP RMS
Contributors: Dr Yadlapalli Kumar, Consultant Paediatrics RCHT
Version: 1.0