Puberty is the process through which reproductive competence is achieved and comprises
gonadarche and adrenarche. Breast development is the initial physical finding of pubertal
onset in girls and typically occurs between 8 and 13 years. Menarche normally occurs
2 to 3 years after the onset of breast development. Pubertal onset is controlled by
the gonadotropin-releasing hormone pulse generator in the hypothalamus; however, environmental
factors such as alterations in energy balance and exposure to endocrine-disrupting
chemicals can alter the timing of pubertal onset. Improvement in nutritional and socioeconomic
conditions over the past two centuries has been associated with a secular trend in
earlier pubertal onset. Precocious puberty is defined as onset of breast development
prior to 8 years and can be central or peripheral. Delayed puberty can be hypogonadotropic
or hypergonadotropic and is defined as lack of breast development by 13 years or lack
of menarche by 16 years. Both precocious and delayed puberty may have negative effects
on self-esteem, potentially leading to psychosocial stress. Patients who present with
pubertal differences require a comprehensive assessment to determine the underlying
etiology and to devise an effective treatment plan.
Keywords
precocious puberty - delayed puberty - adrenarche - gonadarche
