Aetiology

The most common cause of delayed puberty is constitutional (self-limited) delay which accounts for about 90% of cases in both males and females. It tends to occur within families (50% to 75% of cases) and is associated with short stature that is appropriate for the bone age. (1)

Other causes include: (2)

• hypothalamic suppression e.g. systemic illness, anorexia nervosa
• chromosomal abnormalities e.g. Klinefelter's, Turner's
• gonodotrophin releasing hormone deficiency, pituitary lesion e.g. cranipharyngioma, gonadal failure, hypothyroidism, hyperprolactinoma

Reference

1. Howard SR, Dunkel L. The genetic basis of delayed puberty. Neuroendocrinology. 2018;106(3):283-91.
2. Klein DA, Emerick JE, Sylvester JE, et al; Disorders of Puberty: An Approach to Diagnosis and Management. Am Fam Physician. 2017 Nov 1;96(9):590-599.