Puberty, the process of physical maturation, varies in timing among children.
Girls typically begin puberty between 8 and 13 years, while boys start between 9 and 15 years. Pubertal disorders can manifest as either precocious (early) or delayed puberty.
Early puberty can lead to children maturing earlier than peers, potentially resulting in a shorter adult height. It may also pose emotional and social challenges.
Delayed puberty is often a natural variation, where a child is a 'late bloomer', and does not usually require treatment. These children will progress normally through puberty once it begins. But those who do not progress into puberty normally may require further evaluation and management.
Causes of Pubertal Disorders
Puberty is initiated by the hypothalamus, which releases Gonadotropin-Releasing Hormone (GnRH). GnRH stimulates the pituitary gland to release luteinising hormone (LH) and follicle-stimulating hormone (FSH), leading to sex steroid production (oestrogen in females, testosterone in males) and the physical changes of puberty.
Precocious (Early) Puberty
It is more common in girls but may occur in both sexes.
Early puberty can be categorised into:
Central Precocious Puberty (CPP): Triggered by early hypothalamic GnRH release
Peripheral Precocious Puberty (PPP): Caused by early sex steroids production from ovaries, testicles or adrenal glands
Delayed Puberty
More frequently seen in boys, delayed puberty often reflects familial growth patterns. However, chronic illnesses like anorexia nervosa, diabetes, heart disease or kidney disease can also delay puberty.
Appropriate management of these conditions may mitigate delayed puberty risks. In addition, certain genetic conditions or syndromes may also be associated with delayed, arrested or absent puberty and will require further evaluation and management.
Signs and Symptoms of Pubertal Disorders
Physical changes during puberty include:
Development of secondary sexual characteristics, such as pubic and underarm hair, breast development in girls, and growth of the penis and testicles in boys
A growth spurt leading a rapid increase in height
Changes in body shape and size
Early puberty is characterised by the onset of secondary sexual characteristics before age 9 years in boys and before age 8 years in girls. Delayed puberty is characterised by the absence of testicular enlargement in boys by age 14 years and the absence of breast development in girls by age 13 years.
Girls experience breast development and menstrual periods, while boys undergo testicular and penile enlargement, facial hair growth and voice deepening during puberty.
Diagnosis and Treatment Options for Pubertal Disorders
Precocious (Early) Puberty
Diagnostic tests may include a hand X-ray to assess bone maturation, pelvic ultrasound, GnRH stimulation test for hormone levels and possibly an MRI of the pituitary gland/brain to assess for potential triggers for the early puberty.
CPP can be treated with medication to halt pubertal progression. Treatment for PPP varies depending on the cause and may involve medication or surgery, such as in the case of a tumour.
Delayed Puberty
Treatment depends on the underlying cause. Healthy late bloomers typically require reassurance and close monitoring. Hormone replacement therapy with testosterone or oestrogen may be indicated in select cases.
Tips for Talking to Children About Puberty
Begin discussions about puberty around age 8, or earlier if signs of early puberty are present.
It is crucial to prepare your child, especially girls, for bodily changes and menstruation to alleviate fear or trauma.
Research on Pubertal Disorders
Continued clinical research is essential for advancing paediatric healthcare. Our doctors are committed to contributing to the future of child health and medicine through both clinical practice and research.
