Normal Puberty

Question 1

When does puberty begin and what is the average age?

Answer 1

Age 8 - 14

10 is the average for girls and 11 is the average for boys

Question 2

What is puberty defined as?

Answer 2

The onset of secondary sexual characteristics

Question 3

What are the secondary sexual characteristics for males?

Answer 3

• Testes enlargement >4ml (measured with an orchidometer)
• Growth
• Deep Voice
• Chest/facial and axillary hair

Question 4

What are the secondary sexual characteristics for females?

Answer 4

• Breast enlargement (Tanner score)
• Enlargement of uterus and vagina
• Growth
• Pubic/axillary hair
• Menorrhea (oestrogen building up endometrium)

Question 5

What is concordance?

Answer 5

Puberty follows concordance, meaning that it should progress in a particular development sequence

Question 6

What is the concordance pattern for males?

Answer 6

1. Testicular enlargement
2. pubic and and axillary hair
3. growth

Question 7

What is responsible for the male onset of puberty?

Answer 7

Testosterone

Question 8

What cells release testosterone?

Answer 8

Leydig Cells

Question 9

What is the concordance pattern for females?

Answer 9

1. Breast enlargement
2. Pubic and axillary hair
3. Growth

Question 10

What is responsible for the female onset of concordant puberty?

Answer 10

Oestrogen

Question 11

What organs are responsible for the sex hormones and what is the process of their release called?

Answer 11

• Gonads
• Gonadarche

Question 12

What is adrenarche?

Answer 12

• This is the process whereby adrenal androgens are released from the adrenal Zona Reticularis.
• This causes the onset some sexual characteristics, mainly acne, penis growth, labia growth pubic and axillary hair and greasy skin but NOT TESTICLE/BREAST ENLARGEMENT
• This can occur up to a year before normal gonadarche

Question 13

What signals the end of growth and what is Kallmans syndrome?

Answer 13

• The fusion of the epiphyseal growth plates as a result of oestrogen.
• Kallmans is a syndrome where people grow very tall as they don’t make GNRH. This means no testosterone or oestrogen is formed so fusion doesnt occur and GH continues to work. They also have anosmia and as there is no sex hormones, hypogonadism

Question 14

What is thelarche?

Answer 14

The onset of breast development with no axillary hair/odor/acne etc.

Investigations are normal and oestrogen is low as expected

It is a benign condition that is followed up to ensure that precocious puberty doesnt occur.