Differentials abnormal timing of puberty

Question 1

Differentials delayed onset puberty

Answer 1

Constitutional delay
Chronic illness/malnutrition - eating disorder

PRIMARY hypogonadism

• Turner, Kleinfelter
• Radiation/chemo
• Infection/autoimmune

SECONDARY hypogonadism

• Kallman syndrome
• Radiation/trauma/surgery
• Tumours

Question 2

Differentials for precocious puberty

Answer 2

CENTRAL (GnRH dependent)

• CNS tumour (pineal, hypothalamic)
• CNS trauma e.g. radiation
• Genetic: kisspeptin gain of function
• Syndromic - NF1, TS
• Familial

PERIPHERAL (GnRH independent)

• CAH
• McCune Albright
• Gonadal/adrenal tumours
• Exogenous exposure to sex steroids