Delayed puberty


Reassure

Puberty started after age eight in girls, after age nine in boys
No excess fluid intake or urine production
No symptoms of raised intracranial pressure
No associated high risk conditions.
Normal examination

Action

Reassure







Review/refer

Puberty started after age eight in girls, after age nine in boys
No excess fluid intake or urine production
No symptoms of raised intracranial pressure
No associated high risk conditions.
Normal examination

Action

Refer for a paediatric endocrinologist assessment




Scan

Early, delayed or arrested puberty, and;
Excess fluid intake and urine production, or;
One or more other symptoms attributable to a brain tumour, or;
Abnormal neurological examination

Action

Refer for an MRI scan







Examination/assessment

  • • Determine how long patient/parents/carers have had concerns about pubertal status

  • • Ask about family history of early/delayed puberty

  • • Ask specifically about associated symptoms and risk factors for brain tumours.

  • • Determine pubertal status

  • • Check testicular volume in boys

  • • Plot height and weight on growth chart

  • • Full visual assessmen

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    Persistent/recurrent headache

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    Balance/co-ordination/walking problems

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    Persistent/recurrent vomiting

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    Abnormal eye movements

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    Blurred or double vision/loss of vision

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    Behaviour change

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    Fits or seizures

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    Abnormal head position such as wry neck, head tilt or stiff neck

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    Delayed puberty

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    Increasing head circumference



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