Puberty

Question 1

What is the normal age for puberty in boys and girls?

Answer 1

Boys: 10-14 years old
Girls: 8-12 years old

Question 2

What changes occur in puberty in girls?

Answer 2

Breast development
Pubic hair
Growth Spurt
Menarche (usually occurs ~ 2 years into menarche)

May also experience acne and mood changes

Question 3

What changes occur in puberty in boys?

Answer 3

Testicular enlargement to greater than 4ml is the first sign of puberty

Pubic hair growth follows testicular enlargement

When testicular size is ~ 12-15ml then there is a growth spurt

May also experience acne and mood changes

Question 4

What is delayed puberty?

Answer 4

Delayed puberty is defined as the absence of pubertal development by:

• 14 years of age in females
• 15 years of age in males

More common in males

Question 5

What are the causes of delayed puberty?

Answer 5

• Normal for the individual
• Low gonadotrophin levels due to systemic disease (CF, anorexia, crohns, hypothyroidism)
• High gonadotrophin levels (chromosomal, acquired gonadal damage)

Question 6

How should you investigate delayed puberty?

Answer 6

Boys: testicular assessment

Girls: Karyotyping for turners

Also check thyroid hormones and sex steroid hormones.
Pelvic US can be used to assess uterine size and endometrial thickness.

Question 7

What is precocious puberty?

Answer 7

It is early puberty.

Before 8 years old in girls and before 9 in boys.

It is much more common in girls.

Question 8

How can precocious puberty be categorised?

Answer 8

Gonadotrophin dependant causing premature activation of the hypothalamic-pituitary-gonadal axis

Gonadotrophin independent as a result of excess sex hormones

Question 9

What are the causes of precocious puberty in girls?

Answer 9

Often normal with organic causes being rare.

Organic causes:

• Congenital adrenal hyperplasia or androgen secreting hormone (causing early pubic hair and masculine features)
• Neurological causes (accompanied by neuro signs and symptoms)

Question 10

What are the causes of precocious puberty in males?

Answer 10

Almost always pathological.

Testicular examination can help determine the cause:

• Bilateral enlargement suggests gonadotropin release, usually from an intracranial lesion
• Small testes suggests an adrenal cause (e.g. a tumour or adrenal hyperplasia)
• A unilateral enlarged testis suggests a gonadal tumour

Question 11

How would you investigate precocious puberty?

Answer 11

Testicular examination 
Pelvic US (in girls)

Bloods:
Sex steroids/hormones
Gonadotrophin
TFT's
Adrenal steroid precursor (raised in congenital adrenal hyperplasia)

Imaging:
Wrist Xray to assess bone age
Head scan if suspicious