Pubertal Disorders
Puberty is the process a child’s body goes through as it develops into an adult’s body. A pubertal disorder is when these processes and changes don’t occur as they normally should. If puberty occurs too early or is delayed, you need to get your child checked out as early as possible.
Types of Pubertal Disorders Include:
- Delayed puberty – puberty hasn’t started by the age of 13 years in girls and 14 years in boys.
- Precocious puberty – puberty begins too early i.e. before 8 years in girls and 9 years in boys or menses before 9 years in girls.
- Contra sexual pubertal development – development of male characteristics in females.
- Premature thelarche – breast development without any other signs of puberty.
- Premature adrenarche – the appearance of hair in the pubic or underarm area without any other signs of puberty
What is puberty?
Puberty is the stage in a child’s life during which he or she matures physically (sexually) and becomes an adult. e.g.
- Breast development in girls,
- Increase in the size of the testes in boys,
- Appearance of hair in the pubic area and underarms for both.
How does puberty occur?
Puberty starts under the influence of hormones secreted by the pituitary gland, which is a small gland present in the brain. The gland gets active between 8-13 years in girls and 9-14 years in boys. It produces 2 hormones called LH and FSH. These 2 hormones act on the ovaries in girls and testes in boys. The ovaries start producing the female hormone estrogen in response to the LH and FSH, which results in breast development, enlargement of the uterus, and results in menstruation (periods) after 1-2 years.
The testes in boys start enlarging in response to the pituitary hormones and secrete a hormone called testosterone. Testosterone results in the appearance of sexual hair, enlargement of the penis, deepening of voice and facial hair.
The appearance of hair in the pubic and axillary area and the penile enlargement are controlled by another gland called the adrenal glands that are located above the kidneys. These glands produce certain hormones called the DHEA,17a(OH)progesterone, and Testosterone, which are responsible for the appearance of sexual hair. This has been termed adrenarche (activation of adrenal glands).
At what age should these changes occur in a child?
These changes in the body typically start at an average of 11 years in girls and 12 years in boys.
What is early/precocious puberty and what are the symptoms?
Early puberty is the:
- – Development of breasts and hair in the pubic and underarm area before the age of 8 years in girls
- – An increase in the size of the testes or hair in the pubic and underarm area before 9 years in boys.
Is early puberty common?
Early puberty is more common in girls compared to boys, although boys can also develop this problem.
Do I need to consult a doctor for this?
Yes, it is very important for you to get in touch with your pediatrician or a pediatric endocrinologist if you notice
- – Breast development or sexual hair before 8 years in girls or
- – If girls have periods before the age of 9-10 years and
- – If boys have sexual hair or an increase in the size of the testes or size of the penis before 9 years of age. A specialist would be needed to measure the size of the testes in boys with a special instrument called the orchidometer to confirm the increase in size.
Seeing signs of early puberty in your child can be worrisome, but don’t worry. It is treatable.
What are the common causes of early/precocious puberty?
In most cases of girls with precocious puberty, the cause is unknown. In girls with signs of puberty before 6 years and in all boys, early puberty could be due to an abnormality of the pituitary gland. An MRI may be needed to look for an abnormality in the pituitary gland.
Occasionally girls could get breast development due to a cyst in the ovary. The early appearance of hair in the pubic or underarm area in girls and boys could be due to an abnormality of the adrenal gland. This can also cause an enlargement of the penis in boys and the clitoris in girls.
What are the effects of precocious puberty?
Most children who begin puberty early are tall compared to other children of their age, but stop growing earlier too, resulting in a short final height. This occurs because their bone age (skeletal maturation) is advanced and their bones fuse early. It also results in early reproductive capacity.
Does early puberty lead to early mental maturation?
Early physical changes do not result in early mental maturation; hence the child may be too immature to deal with the changes in their body.
They tend to be treated by others according to their appearance, rather than their actual age. Children who look older than their age are at an increased risk of sexual abuse, hence appropriate precautions should be taken. Encourage your child to discuss with you any worries or concerns that he/she may be having.
How do I explain to my child about these changes occurring in their body?
The child may feel embarrassed by the physical effects of puberty. The child should be told that all children experience puberty, but in his/her case it has occurred sooner than usual. He/she should know that these changes in their body are normal, and the children should be allowed to participate in their normal activities.
How is it diagnosed?
Early puberty is suspected based on the physical examination. Laboratory tests are important to determine which puberty hormones are present, and where they are coming from. These may include X-rays of the wrist and hand for bone age (skeletal maturation), hormonal tests of the blood involving multiple samples, ultrasonography of the uterus and ovaries, and Magnetic Resonance Imaging.
How is it treated?
Medicines are available to slow or stop early puberty. This also improves the growth outcome. Rarely surgery is needed to remove ovarian cysts or other ongoing sources of puberty hormones.
What Is Delayed Puberty?
If pubertal changes do not occur in a girl by 13 years of age and in a boy by 14 years of age, puberty is delayed.
Delayed puberty is more common in boys compared to girls.
What Causes Delayed Puberty?
There are several reasons why puberty may be delayed. In boys, it could be a pattern of growth and development in the family. This is called constitutional delay (late bloomer).
