Feature Article

Disorders of pubertal timing in young people




Precocious or delayed puberty can cause major concern to young people and their families and may signify underlying pathology. Detailed history taking and examination, including assessment of pubertal status, followed by investigation of bone age and, if indicated, hormone levels can help GPs decide the next step. Depending on the presentation, management ranges from reassurance and monitoring to urgent investigation and referral to a paediatric endocrinologist.

Key Points

  • Puberty involves the development of secondary sexual characteristics and reproductive function, associated with acceleration and completion of linear growth.
  • Accurate assessment of the stage of puberty depends on inspection and palpation to assess breast development in girls and testicular volume in boys.
  • Precocious puberty is defined as puberty beginning before the age of 8 years in girls and 9 years in boys; it is usually idiopathic in girls but may be a sign of underlying pathology, especially in boys.
  • Delayed puberty is puberty beginning after the age of 13 years in girls and 14 years in boys; it is mainly constitutional but may also result from primary gonadal failure and defects of hypothalamic or pituitary function.
  • Early referral of young people with precocious or delayed puberty is important for timely investigation, management and prevention of short stature and psychosocial problems.

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