Approach to delayed puberty Quiz: Ace Your Exams
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A 14-year-old boy presents to the clinic with concerns regarding delayed sexual development. The patient states that his genitals look different from his peers when he changes in gym class, and he is shorter than the rest of his class. There is no history of headaches, visual disturbances, or neurological deficits. His parent reports that when he was growing up, he was short until the age of 17 years when he had a growth spurt associated with the development of pubic hair and a deepened voice. Past medical and surgical history are noncontributory. Temperature is 37°C (98.6°F), pulse is 86/min, respirations are 19/min, and blood pressure is 120/75 mm Hg. Growth charts show his height consistently at the 3rd percentile since the age of 2 and his weight at the 25th percentile. On physical examination, there is no pubic hair, no gynecomastia, and testicular volume is 3 mL. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone levels are low. Thyroid and prolactin levels are normal. X-ray of the left-hand shows his bone age consistent with 11 years of age. Which of the following is the most likely underlying cause of delayed sexual development in this patient?
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