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Pediatric and adolescent gynecologic endocrinology
A J Morales1, J P Holden, A A Murphy
1University of California, School of Medicine, Department of Reproductive Medicine, San Diego, CA 92103.
Current Opinion in Obstetrics & Gynecology
|December 1, 1992
Summary
Puberty is a transformation to adult reproductive function, with hormonal changes driving development. Understanding its triggers and diagnosing conditions like premature or precocious puberty are crucial for appropriate management.
Area of Science:
- Endocrinology
- Pediatric Endocrinology
- Reproductive Medicine
Background:
- Puberty marks the transition from infantile to adult reproductive states, driven by gonadal hormones.
- Key events include the development of secondary sexual characteristics, gametogenesis, and reproductive capability.
- Adrenarche, the secretion of adrenal androgens, typically begins between ages 6-8, preceding or coinciding with pubarche.
Purpose of the Study:
- To outline the developmental stages and hormonal basis of puberty.
- To differentiate between typical and atypical premature pubarche and precocious puberty.
- To highlight the importance of accurate diagnosis for effective therapeutic strategies.
Main Methods:
- Review of the physiological processes of puberty and hormonal signaling.
- Classification of premature pubarche (typical/atypical) and precocious puberty (complete/incomplete).
- Discussion of diagnostic approaches, including corticotropin testing for atypical cases.
Main Results:
- Puberty onset varies by sex (girls: ~age 8-16; boys: ~age 10-18).
- Atypical premature pubarche necessitates testing for adrenal enzyme deficiencies.
- Precocious puberty requires categorization based on hypothalamic-pituitary axis activation for treatment selection.
Conclusions:
- Continued follow-up is essential for children with premature pubarche.
- The precise trigger for puberty onset remains an area of active research.
- Effective treatment of precocious puberty, such as with gonadotropin-releasing hormone agonists, depends on accurate classification.