This means delayed in the development of the features characteristic of puberty up to the age of 17 to 18 years. In some cases the delay may be because of environmental influence on the hypothalamus and in other it may be without any cause. This could be familial. Usually there is a family history of delayed puberty.
In a case of delayed puberty, the menstruation is irregular and infrequent. The woman may have prolonged periods of amenorrhea or scanty menstrual losses.
These women do not need any treatment. Only reassurance and follow up is enough in a majority of these cases.
Occasionally, puberty may take place early, but regular menstruation cycles do not establish until late teens. A normal pelvic ultrasound scan is quite reassuring, especially for the mothers.
If puberty takes place before the age of 10 years, it is called precocious puberty. It may happen as early as 2nd or 3rd year of life. In a girl with precocious puberty, the physical growth is stunted. This is due to early closure of epiphyses. This puberty could be complete, involving all parts of the body which is due to early production of GnRH. Without it may be incomplete, manifesting only some aspects of puberty.
In majority of the cases no cause is found, then it is called constitutional. In a few cases the cause of precocious puberty may be due to:
- Tumor of central nervous system, which may arise from pituitary, midbrain and hypothalamus.
- Meningitis and encephalitis
- Feminizing ovarian tumors like granulosa cell tumor and theca cell tumors
- Heterosexual puberty from adrenal tumors. Patients show virilization. E.g. excessive growth of hair, coarse skin and husky voice.