Disorders of puberty

Abstract

In both sexes the pubertal development is characterised by wide variability, most pronounced in the form of constitutional delay or acceleration of puberty. The Tanner stages are the standard for the clinical assessment of pubertal stages. In precocious puberty as well as in delayed puberty, growth and bone maturation do not correspond to age. Exact diagnostic procedures are necessary for efficient treatment of the pubertal disorder. Disturbance of pubertal development can be a symptom of another underlying disease, for instance a tumour. Beside imaging techniques the measurement of serum concentrations of gonadal and adrenal steroids is necessary for the diagnostic work-up. The gonadotropin-dependent central precocious puberty can often successfully be treated with GnRH-agonists. In pseudoprecocious puberty, which is independent from the physiological GnRH-gonadotropin axis, treatment should be focussed on the underlying disease. Delayed puberty can be due to hypothalamic, pituitary or gonadal disorders. Usually in all three forms of hypogonadism the substitution of gonadal steroids is generally recommended for the long-term treatment.