Puberty is a stage of cognitive, psychological and biological development. Although growth and the appearance of secondary sexual characteristics are the most obvious markers of the onset of puberty, changes in body composition and cognitive development are also significant.

Although puberty occurs naturally, it may be a difficult changeover for many teenagers, and it offers even more obstacles when it occurs prematurely or late.

What is the Physiology of Puberty?

• Adrenarche
• Pubarche
• Menarche
• Gonadarche

Types of Puberty Disorders

1. Precocious Puberty

Precocious puberty refers to the early onset of puberty, typically before the age of 8 in girls and 9 in boys. This condition causes the early development of sexual characteristics, such as breast growth, pubic hair, and even menstruation in girls or voice deepening in boys.

Causes:

• Central Precocious Puberty (CPP): This is the most common type, caused by premature activation of the hypothalamus and pituitary gland. It may result from conditions such as brain tumours, infections, or head trauma, but often, the cause is unknown.
• Peripheral Precocious Puberty: In this less common type, the issue lies in the gonads or adrenal glands, causing the early release of sex hormones without the brain's involvement. It can be linked to hormone-secreting tumours or genetic conditions like McCune-Albright syndrome.

Symptoms:

• Early breast development in girls
• Testicular and penile enlargement in boys
• Growth spurts
• Body odour
• Mood swings or emotional changes

2. Delayed Puberty

Delayed puberty is defined as the absence of physical signs of puberty by age 13 in girls and age 14 in boys. It can be caused by a variety of factors, ranging from genetic conditions to chronic medical problems.

Causes:

• Constitutional Delay: This is a common, benign cause where puberty starts later but progresses normally. Often, there is a family history of late bloomers.
• Chronic Illnesses: Conditions like cystic fibrosis, kidney disease, or malnutrition can delay puberty.
• Hormonal Disorders: Issues with the hypothalamus, pituitary gland, or gonads can lead to hormonal imbalances that stall puberty. Examples include Kallmann syndrome and hypogonadism.

Symptoms:

• Lack of breast development by age 13 in girls
• Absence of testicular enlargement by age 14 in boys
• Slow growth rate
• Lack of pubic hair or other secondary sexual characteristics

3. Hypogonadism

Hypogonadism is a condition in which the body doesn’t produce enough sex hormones, either due to problems with the gonads or the hormonal pathways that regulate them.

Types:

• Primary Hypogonadism: Caused by a problem in the gonads themselves. Conditions like Turner syndrome in girls or Klinefelter syndrome in boys can lead to this.
• Secondary Hypogonadism: This occurs when the hypothalamus or pituitary gland fails to send the proper signals to the gonads. Causes include tumors, brain injury, or genetic conditions like Prader-Willi syndrome.

Symptoms:

• Delayed or absent puberty
• Reduced muscle mass
• Infertility or underdeveloped reproductive organs
• Osteoporosis or fragile bones

Growth Disorders in Adolescent Age

One of the worst aspects of teenage development issues is the way it may make a young person feel strange. The adolescent probably hates being different more than anybody else. Height gain occurs constantly, although in an atypically nonlinear fashion.

There are 3 distinct phases of maturation:

1. The first stage is the new-born stage, when the child’s height increases by 30-35 sm in just 2 years

2. The second stage, childhood, sees growth remain relatively constant around 5-7 cm/year; however, it usually slows in late childhood.

3. The third and final stage, puberty, is characterised by a growth spurt of 8-14 cm each year due to elevated levels of both GH and sex steroid hormones.

Summary:

• Central precocious puberty typically starts before 8 years of age.
• It is important to differentiate between the central precocious puberty and peripheral precocious puberty.
• The gold standard for management of central precocious puberty is GnRH analogs
• Management of peripheral precocious puberty is directed at its etiology.
• Delayed puberty is characterised by the absence of breast developement by 13 years in females and by a lack of testicular enlargement by 14 years.
• When feasible, treating the underlying cause of delayed puberty should be the primary focus of treatment.