Editing Delayed puberty (section)

=== History and physical ===

==== Constitutional and physiologic delay ====
Children with constitutional delay are reported to be shorter than their peers, lacking a [[growth spurt]], and having an overall smaller build.<ref name=":8" /> Their growth has begun to slow down years before the expected growth spurt secondary to puberty, which helps differentiate a constitutional delay from an HPG-axis related disorder.<ref name=":7" /> A complete family history with the ages at which parents hit the pubertal milestones can also provide a reference point for the expected age of puberty.<ref name=":11" /><ref name=":0" /> Growth measurement parameters in children with suspected constitutional delay include a height, a weight, the rate of growth, and the calculated mid-parental height which represents the expected adult height for the child.<ref name=":1" /><ref name=":11" />

==== Malnutrition or chronic disease ====
Diet and physical activity habits, as well as history of previous serious illnesses and medication history can provide clues as to the cause of delayed puberty.<ref name=":0" /> Delayed growth and puberty can be the first signs of severe chronic illnesses such as metabolic disorders including [[inflammatory bowel disease]] and [[hypothyroidism]].<ref name=":0" /> Symptoms such as fatigue, pain, and abnormal stooling pattern are suggestive of an underlying chronic condition.<ref name=":11" /> Low [[Body mass index|BMI]] can lead a physician to diagnose an eating disorder, [[undernutrition]], child abuse, or chronic gastrointestinal disorders.<ref name=":11" />

==== Primary failure of the ovaries or testes ====
A [[eunuchoid]] body shape where the arm span exceeds the height by more than 5&nbsp;cm suggests a delay in growth plate closure secondary to [[hypogonadism]].<ref name=":0" /> [[Turner syndrome]] has unique diagnostic features including a webbed neck, short stature, shield chest, and low hairline.<ref name=":11" /> [[Klinefelter syndrome]] presents with tall stature as well as small, firm testes.<ref name=":11" />

==== Genetic or acquired defect of the hormonal pathway of puberty ====
Lacking the sense of smell ([[anosmia]]) along with delayed puberty are strong clinical indications for [[Kallmann syndrome]].<ref name=":7" /><ref>Oxford Endocrinology Library. Testosterone Deficiency in Men. 2008. {{ISBN|978-0199545131}} Editor: Hugh Jones. Chapter 9. Puberty & Fertility.</ref><ref name=":14">Male Hypogonadism. Friedrich Jockenhovel. Uni-Med Science. 2004. {{ISBN|3-89599-748-X}}. Chapter 3. Diagnostic work up of hypogonadism.</ref> Deficiencies in GnRH, the signalling hormone produced by the hypothalamus, can cause congenital malformations including cleft lip and scoliosis.<ref name=":0" /> The presence of neurological symptoms including headaches and visual disturbances suggest a brain disorder such as a brain tumor causing [[hypopituitarism]].<ref name=":0" /> The presence of neurological symptoms in addition to [[lactation]] are signs of high prolactin levels and could indicate either a drug side effect or a [[prolactinoma]].<ref name=":11" />