This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Adolescence, Subject name: Pediatrics
Puberty is said to be delayed in girls, if secondary sexual characteristic fail to appear by: 
Select and explain. 
A. 10 years, B. 12 years, C. 13 years, D. 14 years
D: 14 years
Answer: D: 14 years 
Explanation: Ans. D. 14 yearsDelayed puberty is defined as lack of secondary sexual characteristics by the age of 14 years. Absence of menarche by the age of 16 years or 5 years after pubertal onset also indicates pubertal delay. Delayed puberty may be caused by defects in the hypothalamic- pituitary axis, ovaries or genital tract. Patients with anatomical defects present with amenorrhea with normal breast development. Defects in the hypothalamic- pituitary axis are associated with low gonadotropin levels (hypogonadotropic hypogonadism). This may be related to reversible causes like systemic diseases, malnutrition, eating disorders, hyperprolactinemia and hypothyroidism.