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Puberty and its disorders 

Puberty and its disorders
Puberty and its disorders

Gary Butler

and Jeremy Kirk

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date: 31 July 2021

Puberty is defined as the acquisition of secondary sexual characteristics, with a view to reproductive capability.

Assessment of puberty can be done by Tanner stages or the puberty phases.

Timing of pubertal onset and sequence of changes is carefully controlled.

Premature sexual maturation:

<8 years in girls; menarche <11 years

<9 years in boys.

Central precocious puberty or gonadotropin-dependent precocious puberty:

hormone secretion is similar to normal puberty

may be idiopathic, genetic, or secondary to central nervous system/pituitary tumour or insult

treatment is with gonadotropin-releasing hormone analogues.

Gonadotropin-independent precocious puberty (independent source of sex steroid, e.g. gonadal tumour):

treatment should address the primary cause.

Late puberty:

pubertal events within the later normal range.

Delayed onset of puberty:

absence of secondary sexual characteristics:

>13 years in a girl

>14 years in a boy

Central causes (low follicle-stimulating hormone (FSH)/luteinizing hormone (LH)):

chronic illness

eating disorders


hypogonadotropic hypogonadism.

Peripheral causes (high FSH/LH):

gonadal dysgenesis including chromosomal syndromes, e.g. Turner, Klinefelter

gonadal damage including cancer treatments.


low-dose sex hormone to induce growth and secondary sexual characteristics

recombinant FSH/LH to induce fertility potential.

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