Puberty Tarda

A pubertas tarda marks a delayed development of girls or boys in puberty. There can be various reasons for this. There is often a constitutional developmental delay that also occurred in the parents.

Puberty Tarda

What characterizes pubertas tarda?

Pubertas tarda means the late onset or slowed development of puberty. Sometimes puberty doesn’t happen at all. Both girls and boys can be affected. By definition, pubertas tarda is present when puberty has not started at the age of 13.5 years in girls and 14 years in boys, if more than five years elapse between the onset and the attainment of Tanner stage P5 G5 or if development is dormant for more than 18 months during puberty.┬áSee topbbacolleges for Definitions of Hip Arthrosis.

According to Tanner, the development of puberty is divided into individual stages. They define different stages of development of the primary and secondary sexual characteristics. These include the female breast, female and male genitalia, and pubic hair. Pubertas tarda has no uniform cause. The development is usually made up for later. In rarer cases, however, there is an underlying disease.

Causes

There are many causes of pubertas tarda. A constitutional pubertas tarda is usually present. Here the development delay is conditional. Adolescent developmental delays often occurred in one or both parents. Delayed development is also associated with delayed skeletal maturation. Puberty then proceeds normally, but height is usually in the lower normal range. The constitutional pubertas tarda is not pathological, but only a feature of genetic diversity.

However, pubertas tarda can also be the result of pathological processes. A large number of chronic diseases cause disorders in skeletal growth. These include, for example, Crohn’s disease, cystic fibrosis or diabetes mellitus. But malnutrition also leads to delayed puberty. Mental illnesses such as depression also have an influence on pubertal development.

Primary functional disorders of the gonads often cause hypogonadism with reduced production of sex hormones. These can be genetic, such as Ulrich Turner syndrome in girls or Klinefelter syndrome in boys. Inflammation of the testicles or ovaries also leads to reduced sex hormone synthesis. Secondary functional disorders of the gonads arise from the failure of important releasing hormones, which stimulate the formation of sex hormones.

This is a disease of the pituitary gland. Tertiary functional disorders of the gonads are triggered by diseases of the hypothalamus. In the absence of receptors for the sex hormone testosterone, the primary and secondary male sexual characteristics do not develop despite normal testosterone concentrations in the body. Despite the male genotype, the affected person has a female phenotype. Puberty doesn’t happen.

Symptoms, Ailments & Signs

A pubertas tarda manifests itself in a delayed onset of puberty or a slower development of puberty. Sometimes puberty doesn’t happen at all. The menstrual period (menarche) in girls, the growth of pubic hair (pubarche) and breast development (thelarche) are delayed. In boys, there is a delay in the growth of the testicles and penis.

Overall, skeletal maturity is delayed. A pubertal growth spurt usually does not occur. Therefore, the height differs from that of young people of the same age. In rare cases, the epiphyseal plates close with a delay, resulting in tall growth. The delayed development of puberty can also occasionally cause psychological problems. Additional symptoms vary depending on the underlying condition.

Diagnosis & course of disease

For diagnostic purposes, pubertas tarda is documented using the puberty stages according to Tanner. The anamnesis can already make distinctions between constitutional and disease-related causes. If pubertas tarda occurred more frequently in the family and relatives, it is reasonable to assume that there is a constitutional cause. During the laboratory tests, the androgens, estrogens, the gonadotropins LH and FSH and the prolactin in the blood are determined.

The determination of the gonadotropins can in turn distinguish primary from secondary or tertiary gonad dysfunction. MRI is used to evaluate intracerebral processes in secondary and tertiary dysfunction. The determination of skeletal maturity and bone age are also part of the diagnosis of delayed puberty development. The development of the internal female genitalia is followed via ultrasound scans.

Complications

Since pubertas tarda is most often a symptom of an underlying medical condition, it is often accompanied by complications from these disorders. The delayed onset of puberty is then usually not the trigger for the deterioration in health. This is especially true if chronic diseases such as Crohn’s disease, cystic fibrosis, diabetes mellitus, depression or malnutrition are the underlying cause.

However, serious complications can also occur with endocrine disorders, some of which are congenital or with adenomas of the pituitary gland, as well as with inflammation, bleeding and malignant tumors of the central nervous system, which are not caused by pubertas tarda, but by the actual diseases. However, pubertas tarda, which is only characterized by a harmless constitutional late development, should urgently be treated with the administration of hormones.

Otherwise, delayed skeletal maturation occurs. The pubertal growth spurt does not occur, so that body sizes differ from those of the normal population. In some cases it is even possible that a delayed closure of the epiphyseal plates leads to extreme tall growth. Furthermore, the delayed onset of puberty can lead to severe psychological problems in some affected individuals.

The development of depression up to the risk of suicide or social isolation is possible. Other mental development disorders are also observed. As a rule, hormone therapy should bring good results in the case of constitutional late development. However, if boys have androgen receptor resistance, hormone therapy with testosterone cannot induce puberty either.

When should you go to the doctor?

Pubertas tarda disease must always be treated by a doctor. This disease usually does not heal itself and in most cases there is a significant deterioration in the general condition of the person affected if no treatment is initiated. The earlier pubertas tarda is treated, the better the chances of a positive course of the disease. A doctor should be consulted if the development of puberty is severely delayed. This can manifest itself in girls as a lack of menstrual bleeding and in boys as significantly delayed growth of the testicles and penis.

Likewise, tall stature of the affected person often indicates pubertas tarda and should always be treated early. However, since another disease is usually responsible for pubertas tarda, the underlying disease must be treated first. As a rule, with this disease, a pediatrician or a general practitioner can be consulted. However, further treatment is carried out by a specialist.

Treatment & Therapy

The treatment of pubertas tarda depends on the underlying disease. If a constitutional pubertas tarda is present, treatment is usually not necessary because puberty is delayed but occurs on its own. Surgical, radiotherapeutic or chemotherapeutic measures are used for tumors. Hormone replacement therapy with testosterone in boys and estrogens or progestins in girls can usually induce puberty quickly.

From the age of 13, boys usually receive intramuscular injections of testosterone in the form of depot preparations. However, in the case of androgen receptor resistance, this treatment is ineffective. Girls can be treated with low-dose estrogen preparations from the age of 12. Later, a combination of estrogens and progestins is given.

In some cases, lifelong hormone substitution is necessary to prevent possible deficiency symptoms such as bone loss (osteoporosis). However, hormone therapy should be monitored by experienced endocrinologists to avoid side effects such as severe weight gain, mood swings, physical changes or even the development of cancer.

Prevention

Measures to prevent pubertas tarda are not known. In most cases, the delay in pubertal development occurs regardless of lifestyle. In industrialized countries, malnutrition no longer plays a role as a cause. The influence of improper nutrition on the development of puberty still needs to be investigated.

Aftercare

Follow-up care after successful treatment of pubertas tarda depends on the underlying diseases. Since many of those affected do not produce enough sex hormones themselves even after treatment for pubertas tarda, it may be necessary to take hormones until old age or at least until the age at which menopause is suspected to occur. This is particularly important because a lack of sex hormones reduces fertility and promotes the development of serious bone diseases such as osteoporosis.

Regular visits to the doctor with blood tests are necessary to control the hormone levels in the body. If a tumor was the cause of pubertas tarda, regular check-ups are necessary even after it has been removed in order to detect the recurrence of a tumor at an early stage. If this has been completely removed, however, no further follow-up care is necessary.

If an illness with accompanying massive weight loss, such as anorexia, was the cause of pubertas tarda, regular check-ups with the doctor are also necessary in order to be able to recognize and counteract any impending weight loss at an early stage. In addition, you should actively work on maintaining a normal weight by changing your diet (high in carbohydrates, protein and fat). Dietary supplements can also be helpful. Appropriate long-term therapy should be discussed in detail with the attending physician.

You can do that yourself

If the child shows no signs of the onset of puberty until adolescence, a doctor’s visit is recommended. If pubertas tarda is present, early hormonal treatment can initiate the puberty process and prevent long-term physical and mental problems. In addition, the condition is often based on a disease that needs to be clarified and treated. Therefore, if there is any suspicion, a doctor should be consulted.

If other symptoms occur, such as discomfort or pain, there may be a tumor or another disease. Parents should consult a specialist immediately and discuss further measures with them. Targeted self-help is possible by changing your diet and incorporating exercise into your everyday life. This can regulate the hormonal balance and thereby contribute to the onset of puberty. Parents should also talk to the affected child a lot and explain the causes of pubertas tarda to them. The support of family and friends is particularly important when puberty starts late.

If a drug treatment is initiated, attention must be paid to any side effects and interactions. Further self-help measures are usually not necessary, since puberty usually sets in on its own after comprehensive drug therapy.