Constitutional delay of puberty causes

• Variation of normal (constitutional delay)
• Prolonged high level of physical exertion / being an athlete
• Systemic disease, e.g. Inflammatory bowel disease, chronic renal failure
• Undernutrition e.g. anorexia nervosa, zinc deficiency
• Hypothalamic defects and diseases e.g. Prader-Willi syndrome
• Pituitary defects and diseases e.g. hypopituitarism, Kallmann syndrome
• Gonadal defects and diseases e.g. Turner syndrome, Klinefelter syndrome
• Absence or unresponsiveness of target organs e.g. androgen insensitivity syndrome, mullerian agenesis
• Other hormone deficiencies and imbalances e.g. hypothyroidism, Cushing’s syndrome

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