Advances in reproductive technologies have allowed women with Turner’s syndrome and MRKH to build their families. The most common diagnosis in girls with delayed puberty is gonadal failure. Unlike precocious puberty, the definition of delayed puberty has not changed in recent years, and large studies suggest that the most common diagnosis after evaluation is constitutional delay, however, this is more common in boys presenting with delayed puberty than girls. The optimal method of delivery and age of cessation is not known, but increases in adult height and no obvious reproductive sequelae have been demonstrated. GNRH agonists have become a mainstay of therapy in girls with precocious puberty. The early detection of significant intracranial pathology underscores the importance of the workup in young girls with true precocious puberty, and the close follow up of girls in whom a brain MRI is not initially indicated.

The age for evaluation of precocious puberty has changed in the recent past due to greater understanding of the timing of pubertal development and important racial differences. Significant pathology can result in both advanced and delayed puberty and can result in altered attainment of adult height, secondary sexual characteristics and reproductive capacity. Over half of pubertal timing is considered heritable. Puberty is the period of growth that bridges childhood to adulthood and results in physical and sexual maturity as well as the capacity for reproduction.

Sims 4 pubic hair female