Puberty

Normal pubertal development begins typically from ages 8 to 13 years in girls and ages 9 to 14 years in boys Puberty consists of two separate processes, gonadarche and adrenarche, that can be measured clinically through a Tanner staging system. Gonadarche, clinically noted by testicular and breast growth, is stimulated by the hypothalamic-pituitary-gonadal (HPG) hormonal axis. Adrenarche, causing pubic and axillary hair growth, acne, and body odor, is separately stimulated by activation of androgen production in the adrenal gland. Precocious puberty can be secondary to a central activation of the HPG axis (e.g., central precocious puberty [CPP]), peripheral puberty secondary to elevated sex hormones (estradiol or testosterone), or a normal variant, including benign premature adrenarche, thelarche, or menarche. CPP can be treated with inhibition of the HPG axis using a long-acting gonadotropin-releasing hormone agonist (GnRHa). Delayed puberty can be secondary to a benign constitutional delay of puberty and growth or hypogonadism. Hypogonadism can be due to a transient or permanent process and, if permanent, can be treated with sex hormone (testosterone or estradiol) replacement therapy.