Adult Consequences of Self-Limited Delayed Puberty

Abstract

Delayed puberty is a common condition defined as the lack of sexual maturation by an age ≥2 SD above the population mean. In the absence of an identified underlying cause, the condition is usually self-limited. Although self-limited delayed puberty is largely believed to be a benign developmental variant with no long-term consequences, several studies have suggested that delayed puberty may in fact have both harmful and protective effects on various adult health outcomes. In particular, height and bone mineral density have been shown to be compromised in some studies of adults with a history of delayed puberty. Delayed puberty may also negatively affect adult psychosocial functioning and educational achievement, and individuals with a history of delayed puberty carry a higher risk for metabolic and cardiovascular disorders. In contrast, a history of delayed puberty appears to be protective for breast and endometrial cancer in women and for testicular cancer in men. Most studies on adult outcomes of self-limited delayed puberty have been in small series with significant variability in outcome measures and study criteria. In this article, we review potential medical and psychosocial issues for adults with a history of self-limited delayed puberty, discuss potential mechanisms underlying these issues, and identify gaps in knowledge and directions for future research.

FIGURE 1

Mean SD score for height and mean target height (arrows) of boys with delayed puberty who either had (filled circles and solid line) or did not have (open circles and dashed line) an early reduction in height. *P = .01 between final adult heights. (Reprinted with permission from page 102 of Wehkalampi K, Vangonen K, Laine T, Dunkel L. Progressive reduction of relative height in childhood predicts adult stature below target height in boys with constitutional delay of growth and puberty. Horm Res. 2007;68(2):99–104.)

FIGURE 2

Relative risk and 95% confidence intervals (CI) of coronary heart disease by age at menarche. Reference category is menarche at 13 years of age. The area of the square is inversely proportional to the variance of the log risk. CHD, coronary heart disease; CI, confidence interval. (Reprinted with permission from page 240 of Canoy D, Beral V, Balkwill A, et al; Million Women Study Collaborators. Age at menarche and risks of coronary heart and other vascular diseases in a large UK cohort. Circulation. 2015;131(3):237–244.)