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What do we define as delayed puberty? For what reasons does puberty occur in a child? Mrs. Maria Karantza, Paediatrician-Endocrinologist, Deputy Director of Pediatrics-Adolescent Endocrinology Clinic and MITERA Children’s Diabetes answers every question about early and late puberty
Adolescence or puberty is the process in which the child’s physical, psychological and hormonal development progresses towards maturation and adulthood. During adolescence, children grow taller, gain muscle mass and weight, develop their skeletal structure, and progress through stages of brain and emotional maturation. These changes occur through the action of the hormones of puberty, that is, estrogens and androgens.
Where are estrogens and androgens produced?
These hormones are produced in the ovaries and adrenal glands in girls and in the testicles and adrenal glands in boys. The ovaries and testes are also responsible for the production of eggs and sperm, and the adrenal glands produce, in addition to androgens, adrenaline and aldosterone, hormones that regulate energy, stress and water and salt balance in the body. Both the ovaries and the testes produce estrogens and androgens, but in different concentrations and balance between them. Adolescents produce 10-20 times more testosterone than adolescent girls, hence the greater muscle and bone mass and body hair growth in boys. Girls produce a higher concentration of estrogen which leads to breast and vagina development.
The adrenal glands are small glands located above the kidneys, without affecting kidney function, and adrenal androgens are responsible for adolescent and armpit hair growth, acne, and changes in sweat odor.
What is the age of onset of puberty?
The ovaries and testes begin to activate between the ages of 8-14. Adolescent changes last 4-5 years and the majority of changes occur in the first 2-3 years.
How is my child examined for envenomation?
The endocrinologist examines the child clinically, looks at the growth rate from the health record, orders blood tests, ultrasounds, and a “bone age” wrist x-ray as an indicator of skeletal maturity, and judges whether:
1. there is precocious or delayed puberty
2. there are pathological symptoms related to the diagnosis
Early puberty
What do we define as early puberty?
When there are signs of puberty, i.e. breast development before the age of 8 in girls and an increase in the size of the testicles before the age of 9 in boys, puberty is considered early.
When the signs concern only adolescent or armpit hair growth, acne or change in sweat odor, this is most often due to the production of adrenal androgens, which before the age of 9 in both sexes, is considered early and is called early adrenoche.
We should therefore not confuse early puberty with early adrenarche.
Why does my child have precocious puberty?
In the majority of children who enter puberty early, no pathological cause is found. It often runs in the family. Rarer causes are thyroid diseases, cysts or microadenomas that press on the pituitary gland (the part of the brain that activates the onset of puberty), exogenous use of hormonal preparations, obesity, testicular tumors, etc. During the first quarantine of the COVID-19 pandemic, there was a worldwide noticeable increase in the incidence of precocious puberty, especially in girls.
What is the treatment of precocious puberty?
Puberty inhibition therapy, as it is called, is the administration of GnRH agonists in the form of an injection every 1-3 months until the age when puberty normally begins. Long-term follow-up studies have shown that this treatment is effective and safe.
Delayed puberty
What do we define as delayed puberty?
The onset of puberty after the age of 14 or its insufficient development after the age of 16 is defined as delayed puberty. The time of onset of puberty is very often hereditary, so that both early and delayed puberty occur in members of the same family. In both cases (early or late), endocrinological testing is necessary to rule out pathological causes.
Why does my child have delayed puberty?
The majority of children have constitutive growth and development delay, i.e. there is no pathological cause and often there is a hereditary history. Rarely, there are genetic, nutritional or chronic disease-related causes of delayed implantation.
What is the treatment for delayed puberty?
In the majority of children with idiopathic growth and learning delay, we simply reassure the adolescent and the family. In psychologically burdened boys we may use a three-month regimen of testosterone administration to ‘signal’ the onset of puberty. In other pathological causes, the treatment is individualized depending on the diagnosis and gender.