Common paeds histories - delayed puberty

Question 1

What is the order of pubertal development for boys?

Answer 1

1. Testicular enlargement
2. Pubic hair
3. Penis enlargement
4. Height spurt

Question 2

What is the order of pubertal development in girls?

Answer 2

1. Breast development
2. Pubic/axillary hair
3. Height spurt
4. Menarche

Question 3

What would you want to ask about delayed puberty?

Answer 3

• Order of development
• Previous growth/development
• Height/weight
• Nutrition
• Behavioural changes
• Parents - pubertal ages/height/maternal menaeche

Question 4

What general symptoms would you want to ask about in a child with precocious puberty?

Answer 4

• Fever
• Behaviour
• Activity/apathy/alertness
• General health
• Symptoms of other disease - thyroid, CF, Anorexia, Crohns

Question 5

What neurological synptoms would you want to ask about in a child presenting with precocious puberty?

Answer 5

• Fits/LOC
• Headache
• Dizziness
• Vision/hearing
• WEakness/wasting

Question 6

What features associated with delayed puberty would suggest constitutional delay?

Answer 6

• Majority of cases
• Check FH

Question 7

What features associated with delayed puberty would suggest systemic disease (IBD, CF, Anorexia) as a cause?

Answer 7

Symptoms of underlying disease process

Question 8

What features assocaited with delayed puberty would suggest hypothyroidism as a cause?

Answer 8

• Delayed growth
• Fatigue
• Cold intolerance
• Dry skin
• Coarse hair
• Weight gain
• Menorrhagia

Question 9

What features assocaited with delayed puberty suggest Klinefelter’s as a cause?

Answer 9

• Male
• Small testes
• Gynaecomastia
• Tall and thin

Question 10

What features associated with delayed puberty suggest Turner’s syndrome as a cause?

Answer 10

• Female
• Short stature
• Amenorrhoea
• Webbed neck
• Wide spaced nipples

Question 11

What features associated with delayed puberty suggest PCOS as a cause?

Answer 11

• Oligo/amenorrhoea
• Hirsuitism
• Acne
• Weight gain/obesity

Question 12

What are hypogonadotrophic hypogonadic causes of delayed puberty?

Answer 12

• Systemic disease - CF, IBD, Anorexia
• Hypothyroidism
• Kallmans syndrome
• Intracranial tumour
• Panhypopituitarism
• Syndromal

Question 13

What are hypergonadotrophic hypogandic causes of delayed puberty?

Answer 13

• Klinefelter’s
• Turners
• PCOS
• Steroid hormone enzyme deficiency
• Acquird gonadal damage

Question 14

At what age is puberty regarded as being delayed in boys?

Answer 14

>15

Question 15

At what age is puberty regarded as delayed in girls?

Answer 15

>14 years