The Prevalence and Etiology of Delayed Puberty in Southern Thailand: A 20-Year Experience

Objective: Delayed puberty (DP) arises from various etiologies. Distinguishing self-limited DP (SLDP) from congenital hypogonadotropic hypogonadism (CHH) proves challenging due to similar clinical and biochemical markers during adolescent presentation. To identify the etiology of DP, the associated clinical characteristics, and the predictive factors differentiating SLDP from CHH.Material and Methods: A retrospective study was conducted on 75 patients seeking DP evaluation in a tertiary-care hospital between 2002 and 2021. Etiologies were classified based on clinical and biochemical data.Results: Among the 75 patients (47 boys, 28 girls), the etiologies differed by sex. In boys, SLDP was the most common cause (38.3%), followed by permanent hypogonadotropic hypogonadism (PHH, 29.8%), functional hypogonadotropic hypogonadism (FHH, 25.5%), and hypergonadotropic hypogonadism (HHH, 6.4%). In girls, HHH was the most prevalent diagnosis (57.1%), followed by PHH (17.9%), SLDP (14.3%), and FHH (10.7%). Kallmann syndrome was the leading cause of PHH in boys, while central nervous system (CNS) tumors were the most common cause in girls. Turner syndrome was the predominant etiology among girls with HHH (n=8, 28.5%). In the comparison between SLDP and CHH, micropenis was observed only in CHH boys (p-value=0.01), and cryptorchidism was significantly more frequent in the CHH group (36.4%) than in the SLDP group (5.6%) (p-value=0.05).Conclusion: The etiology of DP showed distinct sex patterns in the Thai population, with SLDP predominant in boys and HHH predominant in girls. Clinical predictors, such as micropenis and cryptorchidism, can help differentiate CHH from SLDP.