Etiology of delayed puberty:
- Commonly, it is familial or idiopathic (60%).
- Hypothalamic and pituitary inadequacy. CT, MRI of sella turcica, FSH, LH level confirm the diagnosis.
- Ovarian causes—Turner’s syndrome, Swyer syndrome, resistant ovary, autoimmune disease, testicular feminizing syndrome, high FSH. Polycystic ovarian disease.
- Development of secondary sexual characters, but no menstruation—absent uterus or cryptomenorrhoea, abstruction in the lower genital tract.
- Malnutrition, anorexia nervosa, childhood illness and vigorous exercise.