Delayed puberty is extremely common condition in both boys and girls. Delayed puberty is defined clinically as the absence of
the first signs of physical and hormonal signs of pubertal development beyond the normal range for the population. In the developed
world, this means the absence of breast development by age 12 years in girls, or absence of testicular enlargement by age 14
years in boys. However, there are racial and ethnic variations in the timing of puberty, such as earlier onset of puberty in African
American girls compared with Caucasian counterparts (Table 1). Puberty may be delayed for several years and still occurs normally,
in which case it is considered constitutional delay, a variation of healthy physical development. Delay of puberty may also occur
due to undernutrition, chronic illness or systemic disease, or to defects of the reproductive system (hypogonadism) or the body’s
responsiveness to sex hormones. Any girl of 13 or boy of 14 years of age without signs of pubertal development falls more than 2.5
SD above the mean and is considered to have delayed puberty
a. The normal variation in the age at which adolescent changes occur is so wide that puberty cannot be considered to be
pathologically delayed until the menarche has failed to occur by the age of 18 or testicular development by the age of 20.
b. A 20 years old student (Afghani; born in UAE), had been referred from RAK (May 2008) to Endocrine Clinic (Diabetes &
Endocrine Centre, FGH) for delayed puberty and features of underdevelopment of external genitalia, and diabetes.