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  1. In girls the first visible sign of puberty is the appearance of breast buds (Thelarche) between 8 and 13 years
  2. Followed by pubarche or adrenarche (pubic and axillary hairs
  3. Menarche menses typically begins 2- ½ yr. later (normal range 9-16 years), just after the peak in height velocity
  4. In boys testicular enlargement begins as early as 9 year. Peak growth occurs when testis volumes reach approximately 9-10 cm3
  1. Precocious Puberty
Puberty before the age of 8 yrs in girls or 9 yrs in boys is considered precociousQ
Menarche before the age of 10 yrs in girls is also considered precociousQ
Central-results from excessive gonadotropins releasing hormone, gonadotropin and target sex hormone
Peripheral Precocious Puberty -due to increased sex steroids from cither the adrenal glands or gonads
Causes in boys
  1. Constitutional   or familial   
  2. Intracranial causes : Tumour in the hypothalamus, squeals of encephalitis, HydrocephalusQ  
  3. Congenital adrenal hyperplasia
  4. Testicular tumour
  5. HypothyroidismQ  
Precocious puberty in girls is constitutional in the majority of cases
It can be is sexual characters are that of a female or heterosexual secondary sexual characters resembling those of males.
  1. Constitutional
  2. Intracranial causes
  3. Tumours
  4. Hydrocephalus
  5. Adrenal causes
  6. Adrenocortical tumour
  7. HypothyroidismQ
  8. Hepatic carcinoma
  9. Ovarian tumor heterosexual
  10. Albright syndromeQ
  11. Drugs anabolic asteroids
  12. Hormones
  1. Delayed puberty
Constitutional delay
  1. The diagnosis of delayed puberty is made when signs of sexual development such as increase in the volume of testes are not evident even by the age of 14 years in boys and breast budding by 13 years in girls. The incidence of delayed puberty is reported to be about 25/1000. Boys are more affected than girls.
  2. The most common cause in boys is constitutional delay in puberty. Turner syndrome is common in girls. Central nervous system abnormalities lead to diminished GnRH production, resulting in low gonadotropin secretion.
  3. Etiology of delayed puberty
    1. Chronic systemic diseases: Gluten enteropathy, anorexia nervosa
    2. Constitutional delay in growth and pubertal development.
    3. Hypogonadotropic hypogonadism (Low FSH, LH)
      1. CNS causes: Congenital anomalies, intracranial tumors, inflammatory diseases, traumatic lesions of CNS.
      2. Primary gonadotropin deficiency: Hypopituitarism
      3. Syndromes with gonadotropin deficiency: Kallmann, Prader- Willi; Laurence-Moon-Biedl-Bardet, Frohlich.
      4. Miscellaneous: Hypothyroidism, hyperprolactinemia
    4. Hypergonadotropic hypogonadism (high FSH, LH, Gonadal disorders)
    5. Turner syndrome (45 XO), Noonan syndrome, Klinefelter syndrome (47 XXY).
    6. Anticancer therapy for neoplasms of gonads.
    7. Orchitis
    8. Vanishing testes syndrome
    9. Testosterone biosynthetic defects.
    10. Infiltration and autoimmune disease of gonads.
  4. The following clinical features suggest the diagnosis of constitutional delay in puberty
    1. Family history of delayed puberty,
    2. Delayed bone age,
    3. Normal GH dynamics, low gonadotropins and sex steroids,
    4. Low to normal IGF-1 levels,
    5. Absence of micropenis or cryptorchidism,
    6. No growth spurt, but growth velocity continues at a stable rate with a temporary decrease in velocity just prior to growth spurt, and
    7. Final adult height appropriate for mid-parental height.

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