{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T22:06:29Z","timestamp":1775253989675,"version":"3.50.1"},"reference-count":32,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:p>Delayed puberty (DP) is defined as the lack of pubertal development by an age that is 2\u20132.5 SDs beyond the population mean. Although it generally represents a normal variant in pubertal timing, concern that DP could be the initial presentation of a serious underlying disorder has led to a diagnostic approach that is variable and may include tests that are unnecessary and costly. In this review, we examine available literature regarding the recommended diagnostic tests and aetiologies identified during the evaluation of youth with DP. We view this literature through the prism of the seemingly otherwise well adolescent. To provide further clinical context, we also evaluate the clinical and laboratory data from patients seen with DP in our centre over a 2-year period. The literature and our data reveal wide variability in the number of tests performed and raise the question of whether tests, other than gonadotropins, obtained in the absence of signs or symptoms of an underlying disorder are routinely warranted. Together this information provides a pragmatic rationale for revisiting recommendations calling for broad testing during the initial diagnostic evaluation of an otherwise healthy adolescent with DP. We highlight the need for further research comparing the utility of broader screening with a more streamlined approach, such as limiting initial testing to gonadotropins and a bone age, which, while not diagnostic, is often useful for height prediction, followed by close clinical monitoring. If future research supports a more streamlined approach to DP, then much unnecessary testing could be eliminated.<\/jats:p>","DOI":"10.1136\/archdischild-2015-310375","type":"journal-article","created":{"date-parts":[[2016,5,18]],"date-time":"2016-05-18T03:39:35Z","timestamp":1463542775000},"page":"767-771","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":59,"title":["Evaluation of delayed puberty: what diagnostic tests should be performed in the seemingly otherwise well adolescent?"],"prefix":"10.1136","volume":"101","author":[{"given":"Leah","family":"Abitbol","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Zborovski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark R","family":"Palmert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,5,17]]},"reference":[{"key":"key-10.1136\/archdischild-2015-310375-1","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1136\/adc.45.239.13","article-title":"Variations in the pattern of pubertal changes in boys","volume":"45","author":"Marshall","year":"1970","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2015-310375-2","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1136\/adc.44.235.291","article-title":"Variations in the pattern of pubertal changes in girls","volume":"44","author":"Marshall","year":"1969","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2015-310375-3","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/S0197-0070(80)80005-2","article-title":"Normal ages of pubertal events among American males and females","volume":"1","author":"Lee","year":"1980","journal-title":"J Adolesc Health Care"},{"key":"key-10.1136\/archdischild-2015-310375-4","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1210\/jcem.87.4.8395","article-title":"Delayed puberty: analysis of a large case series from an academic center","volume":"87","author":"Sedlmeyer","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"key-10.1136\/archdischild-2015-310375-5","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1056\/NEJMcp1109290","article-title":"Delayed puberty","volume":"366","author":"Palmert","year":"2012","journal-title":"N Engl J Med"},{"key":"key-10.1136\/archdischild-2015-310375-6","first-page":"697","article-title":"Puberty and its disorders in the male","volume-title":"Pediatric endocrinology","author":"Palmert","year":"2008"},{"key":"key-10.1136\/archdischild-2015-310375-7","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1159\/000053168","article-title":"Diagnosis of late puberty","volume":"51","author":"Argente","year":"1999","journal-title":"Horm Res Paediatr"},{"key":"key-10.1136\/archdischild-2015-310375-8","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1136\/archdischild-2014-307963","article-title":"Recent advances in the understanding and management of delayed puberty","volume":"101","author":"Wei","year":"2016","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2015-310375-9","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1210\/jc.2014-3631","article-title":"Evaluation of 451 danish boys with delayed puberty: diagnostic use of a new puberty nomogram and effects of oral testosterone therapy","volume":"100","author":"Lawaetz","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"key-10.1136\/archdischild-2015-310375-10","doi-asserted-by":"crossref","first-page":"5581","DOI":"10.1210\/jc.2002-020862","article-title":"Pedigree analysis of constitutional delay of growth and maturation: determination of familial aggregation and inheritance patterns","volume":"87","author":"Sedlmeyer","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"key-10.1136\/archdischild-2015-310375-11","doi-asserted-by":"crossref","first-page":"3056","DOI":"10.1210\/jc.2012-1598","article-title":"Distinguishing constitutional delay of growth and puberty from isolated hypogonadotropic hypogonadism: critical appraisal of available diagnostic tests","volume":"97","author":"Harrington","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"key-10.1136\/archdischild-2015-310375-12","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/00006254-198201000-00014","article-title":"Delayed sexual development: a study of 252 patients","volume":"37","author":"Reindollar","year":"1982","journal-title":"Obstet Gynec Survey"},{"key":"key-10.1136\/archdischild-2015-310375-13","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1159\/000182147","article-title":"Etiologies of late puberty","volume":"36","author":"Toublanc","year":"1991","journal-title":"Horm Res Paediatr"},{"key":"key-10.1136\/archdischild-2015-310375-14","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1210\/jc.2007-1786","article-title":"Patterns of inheritance of constitutional delay of growth and puberty in families of adolescent girls and boys referred to specialist pediatric care","volume":"93","author":"Wehkalampi","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"key":"key-10.1136\/archdischild-2015-310375-15","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1542\/pir.22-9-309","article-title":"Delayed puberty","volume":"22","author":"Rosen","year":"2001","journal-title":"Pediatr Rev"},{"key":"key-10.1136\/archdischild-2015-310375-16","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1038\/nrendo.2015.112","article-title":"Expert consensus document: European Consensus Statement on congenital hypogonadotropic hypogonadism\u2014pathogenesis, diagnosis and treatment","volume":"11","author":"Boehm","year":"2015","journal-title":"Nat Rev Endocrinol"},{"key":"key-10.1136\/archdischild-2015-310375-17","first-page":"3990","article-title":"Consensus Guidelines for the Diagnosis and Treatment of Growth Hormone (GH) Deficiency in Childhood and Adolescence: Summary Statement of the GH Research Society 1","volume":"85","author":"Society, GH Research","year":"2000","journal-title":"J Clin Endocrinol Metab"},{"key":"key-10.1136\/archdischild-2015-310375-18","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1515\/jpem.2011.327","article-title":"The pros and cons of sex steroid priming in growth hormone stimulation testing","volume":"25","author":"Wetterau","year":"2012","journal-title":"J Pediatr Endocrinol Metab"},{"key":"key-10.1136\/archdischild-2015-310375-19","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1210\/jcem-73-2-428","article-title":"Spontaneous growth hormone secretion increases during puberty in normal girls and boys","volume":"73","author":"Rose","year":"1991","journal-title":"J Clin Endocrinol Metab"},{"key":"key-10.1136\/archdischild-2015-310375-20","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1159\/000284396","article-title":"Is sex hormone priming in peripubertal children prior to growth hormone stimulation tests still appropriate?","volume":"73","author":"Lazar","year":"2010","journal-title":"Horm Res Paediatr"},{"key":"key-10.1136\/archdischild-2015-310375-21","first-page":"281","article-title":"The impact of gonadal steroid hormone action on growth hormone secretion during childhood and adolescence","volume":"13","author":"Kerrigan","year":"1992","journal-title":"Endocr Rev"},{"key":"key-10.1136\/archdischild-2015-310375-22","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1136\/archdischild-2014-307228","article-title":"Controversies in the diagnosis and management of growth hormone deficiency in childhood and adolescence","volume":"101","author":"Murray","year":"2016","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2015-310375-23","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1177\/0009922808316185","article-title":"Two cases presenting with pubertal delay and diagnosed as Celiac disease","volume":"47","author":"Abaci","year":"2008","journal-title":"Clin Pediatr (Phila)"},{"issue":"Suppl 2","key":"key-10.1136\/archdischild-2015-310375-24","doi-asserted-by":"crossref","first-page":"S506","DOI":"10.4103\/2230-8210.104149","article-title":"Endocrine manifestations of celiac disease","volume":"16","author":"Philip","year":"2012","journal-title":"Indian J Endocrinol Metab"},{"key":"key-10.1136\/archdischild-2015-310375-25","first-page":"1","article-title":"Clinical utility of serologic testing for celiac disease in asymptomatic patients: an evidence-based analysis","volume":"11","author":"Health Quality Ontario","year":"2011","journal-title":"Ont Health Technol Assess Ser"},{"key":"key-10.1136\/archdischild-2015-310375-26","first-page":"43","article-title":"Prevalence of asymptomatic celiac disease in adolescents of eastern Switzerland","volume":"132","author":"Rutz","year":"2002","journal-title":"Swiss Med Wkly"},{"key":"key-10.1136\/archdischild-2015-310375-27","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/1824-7288-39-67","article-title":"Mass population screening for celiac disease in children: the experience in Republic of San Marino from 1993 to 2009","volume":"39","author":"Alessandrini","year":"2013","journal-title":"Ital J Pediatr"},{"key":"key-10.1136\/archdischild-2015-310375-28","first-page":"553","article-title":"The Prevalence of Celiac Disease in Children and Adolescents in Germany","volume":"112","author":"Laass","year":"2015","journal-title":"Dtsch Arztebl Int"},{"key":"key-10.1136\/archdischild-2015-310375-29","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1097\/MPG.0000000000000446","article-title":"Spanish national registry of celiac disease: incidence and clinical presentation","volume":"59","author":"Cilleruelo","year":"2014","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"key-10.1136\/archdischild-2015-310375-30","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1038\/nrgastro.2015.131","article-title":"Extraintestinal manifestations of coeliac disease","volume":"12","author":"Leffler","year":"2015","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"key-10.1136\/archdischild-2015-310375-31","doi-asserted-by":"crossref","first-page":"11208","DOI":"10.1038\/srep11208","article-title":"Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study","volume":"5","author":"Day","year":"2015","journal-title":"Sci Rep"},{"key":"key-10.1136\/archdischild-2015-310375-32","article-title":"An initiative of the ABIM Foundation","author":"Wisely"}],"container-title":["Archives of Disease in Childhood"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2015-310375","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T20:26:48Z","timestamp":1656102408000},"score":1,"resource":{"primary":{"URL":"https:\/\/adc.bmj.com\/lookup\/doi\/10.1136\/archdischild-2015-310375"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5,17]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2016,7,19]]},"published-print":{"date-parts":[[2016,8]]}},"alternative-id":["10.1136\/archdischild-2015-310375"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2015-310375","relation":{},"ISSN":["0003-9888","1468-2044"],"issn-type":[{"value":"0003-9888","type":"print"},{"value":"1468-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5,17]]}}}