PUBERTAL DEVELOPMENT puberty in girls Breast development (thelarche) occurs at 8-12 years of age and menarche occurs 2 years later. Growth spurt occurs shortly before menarche. It is abnormal if a girl does not start menstruating at the age of 15 and needs to be investigated. we should investigate primary amenorrhea at the age of 13 if a girl has not developed secondary sexual characteristics (breast, axillary, and pubic hair) Delayed puberty At 14 years of age in boys, the testicular volume should be at least 4 ml; if it is less than that, it suggests hypogonadism. it can be either primary or secondary hypogonadism. a. primary hypogonadism: Klinefelter syndrome b. secondary hypogonadism: Kallmann syndrome, craniopharyngioma, chronic malnutrition, stress, hypothyroidism, hyperprolactinemia How to differentiate hypogonadism from constitutional delay? In x-ray, in both conditions, bone age lags behind chronological age and lagging of development of secondary sexual character...
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