ABSTRACT
The management of children with constitutional delay is controversial, as many recommend conservative management with observation alone, while others advocate for induction of puberty with sex steroids. The start of puberty is heralded by the appearance of a palpable breast bud in girls and a testicular volume over 3.5 mL in boys. In girls, normal puberty is signalled by breast development followed within 6–12 months by the appearance of pubic hair. Adolescents with precocious puberty and significantly advanced bone age, decreased predicted adult height and a pubertal response to gonadotropin testing should be treated with gonadotropin-releasing hormone agonists to supress pubertal regression and improve final adult height. Oestrogen and testosterone levels rise progressively as puberty progresses. Oestrogen is responsible for breast development and androgens are responsible for pubic and axillary hair, adult body odour, acne and genital enlargement. The pubertal growth spurt lasts for approximately 2 years, after which growth continues at a slower rate until epiphyseal fusion.
