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 characteristics. In constitutional delay, there is family history and growth of child tracks along the lower percentile.



precocious puberty

development of secondary sexual characteristics before the age of 8 in girls and 9 in boys.

Terms to know

pubarche: development of pubic and axillary hair

Adrenarche: development of acne

Idiopathic premature pubarche: isolated pubarche without other features like adrenarche.

what are the causes of precocious puberty?

1. Central causes: CNS tumor, idiopathic

2. Peripheral causes: increased androgens secreted from gonads, adrenal, and exogenous sources.

There is one condition called non-classic congenital adrenal hyperplasia (deficiency of 21 hydroxylase) which is distinct from classic CAH in the sense that there is no salt wasting and features are just excess androgens causing virilization and hirsutism. serum 17-OH progesterone is elevated. Treatment is the administration of hydrocortisone.








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