Delayed puberty in females
The commonest cause for delayed sexual development in girls is simple maturational delay but overt or cryptic chronic illnesses may delay the onset of puberty. This is less of a major problem in girls than in boys as the first sign of puberty namely breast development is immediately noticeable and quickly cause mood changes and very rapid growth. In the absence of breast development a useful next investigation is a pelvic ultrasound which will show follicular changes and ovarian growth if puberty is imminent. If the ovaries are small and pre-pubertal in configuration then raised gonadotropins will detect primary ovarian failure. Low gonadotropins may be present in isolated gonadotropin deficiency or combined genetic syndrome such as Kallman's Syndrome but also due to intra cranial lesions. Eating disorders may significantly delay the onset of puberty and extreme maturational delay can occur.