Delayed puberty

Many patients with delayed puberty are detected or seek medical help because of slow growth rather than slow pubertal development, as well as due to concerns that puberty has not started. The slow growth results from delayed sex hormone secretion and is only rarely due to other causes such as growth hormone deficiency.

Although there are currently no recommended screening programs to detect children with a delay in pubertal development, short stature and a poor growth velocity at secondary school entry should warrant review by a family practitioner. Current interventions are usually directed at speeding up both growth and the pubertal process.

Accurate measurements, using correct age- and sex-specific growth charts, are mandatory. Care must be taken to plot the height and weight based on the child's actual chronologic age.

Growth is strongly related to the genetic potential. The target or midparental height is calculated as follows:

• Girl = ([height of mother + height of father/2) - 7 cm (2.75 inches)

• Boy = ([height of mother + height of father/2) + 7 cm (2.75 inches)

Growth velocity determines the change in height over time. It is calculated as the difference in height on two different occasions annualized over one year. Growth velocities depend on age and pubertal status. Height that plots stably along a given percentile on the growth chart reflects normal growth velocity. Crossing percentiles in a downward direction reflects a poor growth velocity.