Editing Delayed puberty (section)

=== Constitutional and physiologic delay ===
Children who are healthy but have a slower rate of physical development than average have a [[constitutional delay]] with a subsequent delay in puberty. It is the most common cause of delayed puberty in girls<ref name=":3">{{Cite book|title=Williams Gynecology|last=Hoffman|first=Barbara | name-list-style = vanc |publisher=McGraw-Hill Education|year=2016|isbn=978-0-07-184908-1}}</ref><ref name=":4" /> (30%)<ref name=":0" /> and even more so in boys<ref name=":1" /> (65%).<ref name=":7" /> It is commonly inherited, with as much as 80% of the variation in the age of onset of puberty due to genetic factors.<ref name=":7" /><ref>{{cite journal | vauthors = Howard SR, Dunkel L | title = Management of hypogonadism from birth to adolescence | journal = Best Practice & Research. Clinical Endocrinology & Metabolism | volume = 32 | issue = 4 | pages = 355–372 | date = August 2018 | pmid = 30086863 | doi = 10.1016/j.beem.2018.05.011 | series = Issue Update in paediatric endocrinology | s2cid = 51934183 | url = http://qmro.qmul.ac.uk/xmlui/handle/123456789/40963 }}</ref> These children have a history of shorter stature than their age-matched peers throughout childhood, but their height is appropriate for [[bone age]], meaning that they have delayed skeletal maturation with potential for future growth.<ref name=":0">{{Cite book | last1 = Fritz | first1 = Marc A | last2 = Speroff | first2 = Leon | name-list-style = vanc |title=Clinical Gynecologic Endocrinology and Infertility. |date=2015|publisher=Lippincott Williams & Wilkins|isbn=9781451189766|oclc=885230917}}</ref>

It is often difficult to establish if it is a true constitutional delay of growth and puberty or if there is an underlying pathology because lab tests are not always discriminatory.<ref name="WeiCrowne2015">{{cite journal | vauthors = Wei C, Crowne EC | title = Recent advances in the understanding and management of delayed puberty | journal = Archives of Disease in Childhood | volume = 101 | issue = 5 | pages = 481–8 | date = May 2016 | pmid = 26353794 | doi = 10.1136/archdischild-2014-307963 | s2cid = 5372175 | type = Review }}</ref> In the absence of any other symptoms, short stature, delayed growth in height and weight, and/or delayed puberty may be the only clinical manifestations of certain chronic diseases including [[coeliac disease]].<ref name="Mearin2015">{{cite journal | vauthors = Mearin ML | title = The prevention of coeliac disease | journal = Best Practice & Research. Clinical Gastroenterology | volume = 29 | issue = 3 | pages = 493–501 | date = June 2015 | pmid = 26060113 | doi = 10.1016/j.bpg.2015.04.003 | type = Review }}</ref><ref name="LefflerGreen2015">{{cite journal | vauthors = Leffler DA, Green PH, Fasano A | title = Extraintestinal manifestations of coeliac disease | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 12 | issue = 10 | pages = 561–71 | date = October 2015 | pmid = 26260366 | doi = 10.1038/nrgastro.2015.131 | s2cid = 15561525 | type = Review }}</ref><ref name="GuandaliniAssiri2014">{{cite journal | vauthors = Guandalini S, Assiri A | title = Celiac disease: a review | journal = JAMA Pediatrics | volume = 168 | issue = 3 | pages = 272–8 | date = March 2014 | pmid = 24395055 | doi = 10.1001/jamapediatrics.2013.3858 }}</ref><ref name="LevyBernstein2014">{{cite journal | vauthors = Levy J, Bernstein L, Silber N | title = Celiac disease: an immune dysregulation syndrome | journal = Current Problems in Pediatric and Adolescent Health Care | volume = 44 | issue = 11 | pages = 324–7 | date = December 2014 | pmid = 25499458 | doi = 10.1016/j.cppeds.2014.10.002 | type = Review }}</ref>