Definition of Puberty :

Puberty : (Latin Paberius-adulthood).

Define : Puberty in the girls is the period, which links childhood to adulthood. It is the period of gradual development of secondary sexual characteristics. According to the English law this occurs at the age of 12 years in girls and 14 years in boys.

Clinical signs of puberty :

Signs: Tanner & Marshall described five important physical changes during puberty: The most common order-

1. Beginning of the growth spurt.
2. Thelarche : The development of breast is known as thelarche.
3. Adrenarche : The development of axillary & pubic hair is known as adrenarche.
4. Peak growth of height.
5. Menarche : The first menstrual period is known as menarche.

Male Physical and physiological changes in puberty :

1) .External genitalia : 

• Penis increases in lengths & width.
• Scrotum becomes pigmented & rugose.

Internal genitalia : 

• Seminal vesicles enlarges & secrete & benign to form fructose.
• Prostate & bulbourethral glands enlarge & secrete.

Breast :  No changes usually.

Voice : 

• Larynx enlarges
• Vocal cords increase in length & thickness & voice becomes deeper.

Hair growth : 

• Beard appears
• Hairline on scalp recede anterolaterally
• Pubic hair grows with male pattern (triangle with apex up).
• Hair appears in axillas, on chest & around anus general body hair increases.

Body configuration : 

• Shoulders broaden
• Muscles enlarge.

Skin :

• Sebaceous gland secretion thickness and increases (predisposing to acne).

Mental changes : 

• More aggressive, active attitude, interest in opposite sex develops
• Appearance of sexual desire.

Female physical and physiolological changes in puberty : 

External genitalia : 

• Deposition of fat in mons pubis.
• Enlargement of labia majora.
• Enlargement of labia minora.

Internal genitalia : 

• Uterus increases in 2-3 folds.
• Vagina enlarges & stratification of vaginal epithelium.
• Ovary enlarges & follicular growth begins.

Breast : 

• Duct system & stroma of breast.
• Deposition of adipose tissue in breast.

Menstruation : 

Onset of menstruation.

Voice : 

• Larynx remains prepubertal size.
• Voice becomes high pitched.

Hair growth : 

• Pubic hair grows with female patter (apex down).
• Hair appears in axilla.

Body Configuration : 

• Narrow shoulder & broad hip.
• Female distribution of fat mainly in breast & buttock.

Skin : 

• Skin becomes soft, smooth & shiny.
• Secretion of sebaceous gland causes formation of acne.

Mental Changes : 

• Active attitude & mental inclination to the opposite sex developed.
• Appearance of sexual desire.

Abnormalities of puberty :

1. Precocious puberty.
2. Delayed puberty.
3. Menstrual abnormalities:

• Amenorrhoea.
• Menorrhagia.
• Dysmenorrhoea.

  4. Others :

• Infection.
• Neoplasm.
• Hirsuitism

Definition of precocious puberty :

Precocious puberty : The term precocious puberty is reserved for girls who exhibit any secondary sex characteristics before the age of 8 or menstruate before the age of 10.

Causes of precocious puberty :

GnRH dependent- 80%

Complete, central, isasexual or true :

1. Constitutional (commonest)
2. Juvenile primary hypothyroidism
3. Intracranial lesions :

• Trauma
• Tumour
• Infection

Incomplete :

1. Premature thelarche.
2. Premature puberche.
3. Premature menarche.

GnRH independent (precocious pseudopuberty or peripheral)

Ovary : 

1. Granulosa cell tumour.
2. Theca cell tumour
3. Leydig cell tumour.
4. Chorionic epithelioma.
5. Androblastoma.
6. McCune – Albright syndrome.

Adrenal :

1. Hyperplasia.
2. Tumour

Liver :

1. Hepatoblastoma.

Iatrogenic :

1. Oestrogen or androgen intake.

Define delayed puberty

Delayed puberty : Puberty is said to be delayed when the breast tissue and/or pubic hair have not appeared by 13-14 years or menarche appears as late as 16 years.

Causes of delayed puberty :

Hypergonadotrophic hypogonadism :

1. Gonadal dysgenesis, 45 XO.
2. Pure gonadal dysgenesis, 46 XX, 46 XY.
3. Ovarian failure, 46 XX.

Hypogonadotrophic hypogonadism :

1. Constitutional delay.
2. Chronic illness, malnutrition.
3. Primary hypothyroidism.
4. Isolated gonadotrophin deficiency (Kallmann’s syndrome)
5. Intracranial lesions-tumours :

• Craniopharyngioma.
• Pituitary adenomas.

Eugonadism :

1. Anatomical causes:

• Mullarian agenesis.
• Imperforate hymen.
• Transverse vaginal septum.

  2. Androgen insensitivity syndrome.