Disorders of Puberty

Overview

Puberty is the process through which reproductive capability is attained, and it consists of gonadarche and adrenarche. Breast development is the first physical sign of pubertal onset in girls, and it typically occurs between the ages of 8 and 13 years. Menarche usually happens 2 to 3 years after breast development begins. The gonadotropin-releasing hormone pulse generator in the hypothalamus controls pubertal onset; however, environmental influences such as changes in energy balance and exposure to endocrine-disrupting substances can affect the timing of pubertal onset.

Improvements in dietary and socioeconomic conditions have been linked to a secular trend in earlier pubertal onset during the last two centuries. Precocious puberty is described as the commencement of breast growth before the age of eight years, and it can be either central or peripheral. Delayed puberty can be hypogonadotropic or hypergonadotropic, and it is described as a lack of breast growth before the age of 13 or a lack of menarche before the age of 16.

Precocious and delayed puberty can both have a detrimental impact on self-esteem, potentially leading to psychological stress. Patients who appear with pubertal abnormalities require a thorough evaluation to discover the underlying cause and develop an appropriate treatment approach.