Editing Openai/6842ae90-f1b0-8013-890f-f49da7e9b749 (section)

=== Assistant: Here is a simple flowchart that shows the basic approach doctors often use to evaluate delayed puberty: ===
Here is a simple flowchart that shows the basic approach doctors often use to evaluate delayed puberty:

===== <syntaxhighlight lang="plaintext">Step 1: Confirm Delayed Puberty =====
 └─ Girls: No breast development by age 13 OR no menarche by 15
 └─ Boys: No testicular enlargement by age 14

Step 2: Check Growth Pattern
 └─ Is growth normal or slowed?
 └─ Is height below expected based on family (genetic potential)?

Step 3: Look for Red Flags
 └─ Chronic illness?
 └─ Neurological symptoms (headaches, vision changes, anosmia)?
 └─ History of CNS tumor, radiation, trauma?
 └─ Signs of gonadal failure (small testes, amenorrhea, short stature)?
 └─ History of excessive exercise, eating disorder, psychological stress?

Step 4: Basic Labs & Tests
 └─ Bone age X-ray (wrist/hand)
 └─ LH & FSH (low → central cause, high → primary gonadal failure)
 └─ Estradiol (girls) / Testosterone (boys)
 └─ TSH & Free T4 (check for hypothyroidism)
 └─ Prolactin (pituitary function)
 └─ Other tests as needed (celiac screen, inflammatory markers, karyotype)

Step 5: Diagnosis
 └─ Constitutional delay → reassure, monitor
 └─ Chronic illness → treat underlying disease
 └─ Central hypogonadism → MRI brain + treat cause
 └─ Primary gonadal failure → genetic testing, hormone replacement therapy

Step 6: Referral
 └─ Pediatric endocrinologist if cause unclear or if treatment needed

</syntaxhighlight>

===== 👉 If no red flags and growth is normal → often constitutional delay → reassurance & monitoring. =====
👉 If red flags or abnormal labs → investigate further → consider specialist referral.

If you want, I can also give you:
✅ Sample lab values that would point to each type of cause
✅ How doctors treat different types of delayed puberty

Just say if you'd like me to! 📚✨