Puberty disorders occur in both girls and boys and are related to the onset and progression of puberty. Adolescence is an important period during which a child becomes an adult and acquires the ability to reproduce. It is characterised by rapid physical and psychological changes. For girls, adolescence begins between the ages of ten and twelve, while for boys it begins later, between twelve to fourteen.
Some of the most important Puberty disorders include early puberty, delayed puberty and menstrual disorders (in girls).
Puberty disorders: When does adolescence begin?
The hypothalamus is an area of the brain that controls the function of the pituitary gland. Adolescence begins when the hypothalamus prompts the pituitary gland (at the base of the brain) to release hormones (FSH, LH) that stimulate the ovaries to produce oestrogen and the testicles to produce testosterone. Oestrogen and testosterone are responsible for the physical and psychological changes in adolescence.
Puberty disorders: Early Puberty
Early or precocious puberty describes the condition in which the child’s body acquires the primary and secondary characteristics of its sex before the age of 8 for girls and 9 for boys. It presents with increased hormone levels, as well as rapid bone and muscle growth.
Puberty disorders: What is the cause of early puberty?
In girls, early puberty is not usually due to a medical issue, while in boys it may be associated with a disorder of the central nervous system. More rarely, it can be the result of an infection, hormonal disorder, tumour, injury or brain disorder.
Puberty disorders: What are the symptoms of early puberty?
Signs of early puberty in girls:
- Breast development
- Pubic or underarm hair development
- Growth spurt.
And in boys:
- Enlargement of the testicles or penis
- Deepening of voice
- Pubic, underarm or facial hair development
A small number of children may experience partial early puberty, i.e. signs of early puberty when they are very young (up to 2 years of age). For example, some girls develop breasts in the first few months of their lives, which may disappear or continue to exist without further changes related to puberty.
In this case, the child should be examined by an endocrinologist to rule out the possibility of actual early puberty or other health problems. They do not usually require treatment, and signs of puberty occur at the appropriate age.
Puberty Disorders: What are the consequences of early puberty?
Possible consequences of early puberty include:
- Short stature: Once puberty is over, growth stops. The bones of children with early puberty mature faster than normal. Therefore, these children tend to be taller than their peers, but they stop growing earlier, resulting in short stature.
- Psychological problems: Many children with early adolescence are confused and have difficulty coping with the changes occurring in their bodies. They are often aggressive and suffer from decreased self-esteem and risk of depression.
Puberty Disorders: How is early puberty diagnosed?
To diagnose early puberty, the doctor orders the following tests:
- Blood tests
- Wrist and hand x-ray to determine bone age and ultrasound of the ovaries for girls
- Magnetic resonance imaging (MRI) to exclude possible tumours
- It may be necessary to undergo a stimulation test with the administration of intravenous LHRH (this test can be performed at MITERA Children’s Hospital)
Puberty Disorders: How is early puberty treated?
The treatment of early puberty depends on the cause. When due to an underlying cause, the aim is to cure it if possible. If the stimulation test is positive for central precocious puberty: GnRH analogue, which inhibits adolescence and slows down the further development of the child, is administered once a month. The treatment stops when the child reaches the age at which puberty would normally begin.
Puberty Disorders: Delayed Puberty
Delayed puberty is observed when there is:
- No sign of breast development in girls older than 13
- No menstrual cycle in girls over 16 years of age
- No growth in the testicles and penis in boys older than 14.
Delayed puberty is not normally due to pathological causes and is a benign condition. It occurs more often in boys than girls and may be hereditary. In rare cases, delayed puberty can be due to pathological causes such as hypothalamic and pituitary disorders or gonadal (ovarian and testicular) development disorders. These disorders may be due to tumours, chronic diseases, endocrinopathies or syndromes (such as Kallmann Syndrome, Turner Syndrome or Klinefelter Syndrome).
Puberty Disorders: How is delayed puberty diagnosed?
An endocrinologist will take a medical history of the child and the rest of the family and hormone and bone age tests will be performed. Depending on the case, a chromosome test may be ordered (karyotype).
Puberty disorders: How is delayed puberty treated?
Treatment of delayed puberty depends on the cause of the problem. If due to a hormonal disorder, hormone substitution is recommended. When due to chronic illness, the treatment focuses on it. In any case, it is crucial that the child be seen regularly by the endocrinologist to monitor height, weight and the progression of puberty.
Puberty Disorders: Menstrual Disorders
Menstruation is the normal discharge of blood from the vagina every month. Menstruation normally begins between the ages of 10 and 15. Each cycle lasts approximately 28 days. Maintaining a regular cycle is dependent on hormone balance (progesterone, oestrogen). When these hormone levels are disrupted, the cycle is irregular.
Menstrual disorders may be due to a variety of factors, including:
- Excessive exercise
- Growth hormone deficiency
- Polycystic ovarian syndrome (PCOS)
- Turner syndrome
- Thyroid disorders.
Puberty Disorders: What are menstrual disorders?
Menstrual disorders are divided into categories according to the duration of the cycle:
- Frequent menstruation
- Absence of menstruation (Amenorrhea)
- Primary amenorrhea
- Secondary amenorrhea (in adult women).
Based on the amount of blood:
- Light or infrequent menstruation (oligomenorrhea)
- Heavy bleeding (menorrhagia)
- Cycles shorter than 21 days (polymenorrhea)
- Abnormal bleeding from the uterus (metrorrhagia).
Puberty Disorders: How are menstrual disorders diagnosed and treated?
An endocrinologist will order the following tests:
Depending on the results, an appropriate treatment will be recommended. For example, menstrual disorders due to thyroid disorders will be treated with medication.