Initial evaluation of delayed or stalled puberty

CDGP: constitutional delay of growth and puberty; CNS: central nervous system; FHH: functional hypogonadotropic hypogonadism; FSH: follicle-stimulating hormone; IHH: idiopathic hypogonadotropic hypogonadism; LH: luteinizing hormone.

* Reassessment of pubertal progression should involve repeat physical examination 4 to 6 months after resolution of underlying condition. In some cases, FSH, LH, and gonadal steroids (estradiol or testosterone) will be obtained at presentation and may be repeated on subsequent evaluation.

¶ Patients with secondary (hypogonadotropic) hypogonadism may present with LH, FSH, and estradiol or testosterone that are within the normative range for pubertal stage.

Δ FHH is delayed puberty that results from an underlying condition (eg, calorie restriction, celiac disease).

◊ Findings suggestive of CDGP rather than IHH include: childhood growth below expected percentiles, normosmia (intact sense of smell), absence of dysmorphic features/atypical genital development (eg, cryptorchidism, microphallus), family history of self-resolving pubertal delay, and absent adrenarche.

§ Congenital anatomic lesions of the hypothalamus or pituitary include optic nerve hypoplasia and hypoplastic pituitary. Acquired abnormalities of the hypothalamus or pituitary include tumors (eg, craniopharyngioma, prolactinoma). Symptoms concerning for a CNS tumor (eg, headache, visual changes, ataxia, seizure) require urgent evaluation.