Introduction

• For girls, normal range of onset of puberty is between 8-13 years of age, with the onset of puberty being defined by presence of breast development
• For boys, normal range of onset of puberty is between 9-14 years of age, with onset of puberty being defined by testicular volumes of 4mL and above
• Common reasons for delayed puberty include familial/genetics and chronic illness

When to refer

• Absence of breast development in a girl at age ≥13yrs or primary amenorrhoea at age 15yrs
• Testicular volumes <4ml in a boy at age ≥14yrs

Initial work up (if investigations thought to be warranted)

• Thyroid function tests, coeliac serology, FBE, UEC, liver function tests, FSH, LH, oestradiol or testosterone
• Bone age X-ray

  Referral information needed

• Clinical history / associated illnesses or possible reasons for pubertal delay
• Height and weight (and date of assessment)
• Pubertal assessment according to Tanner staging
• History of pubertal timing in parents (particularly menarche in mother) if available
• Copies of pathology and bone age X-ray results

Contact information

• For clinical advice, the endocrinology fellow or endocrinologist on call can be contacted through the hospital switch board (03) 9345 5522
• Outpatient booking enquiry information (03) 9345 6180

Author

• Guideline developed by RCH Endocrinology Department