e-book Chapter 14, Assessment of Maturation: Bone Age and Pubertal Assessment

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Evaluation of Short and Tall Stature in Children

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Create account Why create an account? Sign in via: OpenAthens. This is the touchback warning message modal. Treat with confidence. Trusted answers from the American Academy of Pediatrics. Chapter Puberty: Normal and Abnormal.

Delayed puberty

Robert K. Get Citation. Disorders of pubertal development constitute one of the most frequent referrals to pediatric endocrinology clinics. In many cases, no endocrine problem is found.

A referral may be avoided by a careful evaluation, including family history, and a few simple laboratory procedures. During puberty, a series of complex hormonal changes takes place. The hypothalamus secretes pulses of gonadotropin-releasing hormone GnRH , which stimulates pituitary gonadotropin production of luteinizing hormone LH and follicle-stimulating hormone FSH. Concomitantly, the previously very sensitive hypothalamic-pituitary-gonadal feedback loop becomes less sensitive to the negative effect of gonadal steroids.

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As a result, gonadotropin levels rise, stimulating the secretion of greater amounts of sex steroids, either testosterone or estradiol, depending on the gender of the child, leading to the physical changes of puberty. This process is called gonadarche. The hypothalamic-pituitary-gonadal axis is active during fetal life and infancy until it enters an inactive state during the prepubertal years. It has also been suggested that environmental chemicals capable of disrupting endocrine activity may affect pubertal timing.

Leptin, which is secreted by adipocytes and regulates appetite and metabolism through the hypothalamus, is thought to play a permissive role in regulating the timing of puberty. The mechanism that triggers the maturation of the adrenal cortex at puberty remains poorly understood.


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Delayed puberty - Wikipedia

Although there is considerable variation between individuals, on average puberty begins at the age of 11 in girls and 13 in boys. Puberty that begins abnormally early is referred to as precocious puberty and can be due to a peripheral cause peripheral precocious puberty or a central cause involving the hypothalamo-hypophyseal axis central precocious puberty , or CPP. At the other end of the disease spectrum, puberty may be delayed or absent. This delay can be constitutional, secondary to underlying conditions, or due to hypogonadism. The first visible sign of puberty in males is testicular enlargement, while in females it is breast development.

References: [1] [2] [3] [4] [5]. References: [3] [6].

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Adolescence is the period of physical and psychological development from the onset of puberty to adulthood age of majority. Adolescence is associated with an increased risk of mortality and morbidity due to an increase in risk-taking behavior. Central precocious puberty has a central cause e. References: [1] [2] [7] [8] [9] [10] [11].


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  6. References: [1] [12] [13] [14]. Clinical science Puberty refers to the phase of development between childhood and adulthood in which complete functional maturation of the reproductive glands and external genitalia occurs. This is not pathological. For further details, see physical changes during puberty below.

    Tanner stages Sexual maturity ratings SMR to assess the development of secondary sexual characteristics e. See pubertal gynecomastia. Accelerated growth and early skeletal maturity Central precocious puberty CPP : Premature sexual development typically follows the normal pattern of puberty , except that it is early. Peripheral precocious puberty : may not follow the normal developmental pattern; may exhibit possible features of underlying condition e. Obesity-related precocious sexual development Obesity is associated with early pubertal development Summary of pathomechanism: Obesity causes compensatory hyperinsulinemia due to increased insulin resistance and higher levels of leptin , which both lead to earlier development of sexual characteristics.


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    Definition : absent or incomplete development of secondary sex characteristics by the age of 14 in boys or 13 in girls Etiology Constitutional growth delay most common cause of delayed puberty Definition: a temporary delay in growth and onset of puberty that is not caused by any pathological process Etiology: may be inherited as an autosomal dominant , recessive , or X-linked trait Diagnosis: X-ray showing a bone age that is less than the individual's chronological age Treatment: No treatment is needed, as catch-up growth eventually occurs and the individual reaches a normal adult height.

    Malnutrition and other chronic diseases such as inflammatory bowel disease , hypothyroidism , or psychosocial deprivation Hypogonadism Diagnosis Monitoring over time History: delayed not interrupted!