In girls
lack of breast development by age 13 years (some authors use a cut-off of 12 years)
lack of pubic hair by age 14 years
lack of menarche by age 16 years
or greater than five years between thelarche and menarche.
In boys delayed if testicular enlargement does not occur by 14 years of age
lack of pubic hair by age 15 years
or more than five years are required to complete genital enlargement.
DDx
: constitutional delay of puberty (CDP)
: growth retarding or attenuating disorders, i.e., undernutrition, endocrinopathies, metabolic disorders, and chronic disease
: primary gonadal failure (hypergonadotropic hypogonadism)
: gonadotropin deficiency (hypogonadotropic hypogonadism).
The vast majority of those children who experience delayed puberty will have CDP 
Tanner stage (breast , external genitalia)
Investigation
CBC
Cortisol
LH FSH E2
TSH
GH
Chromosome study
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