Signs Of Puberty Research Articles

Growth in Asthmatic Children Treated with Fluticasone Propionate

1. David BA, 2. Edwin AB, 3. Craig FL, 4. Robert AN, 5. David GT, 6. Mark LV, 7. Peter K, 8. and the Fluticasone Propionate Asthma Study Group (1998) J Pediatr. 132:472–477. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] #### Purpose of the Study To determine whether inhaled fluticasone propionate (FP) has long-term effects on growth in children with persistent asthma. ##### Study Population Three hundred twenty-five prepubescent children 4 to 11 years of age with persistent asthma and in the recent past normal growth rates. ##### Methods The patients were divided into three groups; 106 patients received placebo, 111 patients received FP 50 μg bid, and 108 patients received FP 100 μg bid via a diskhaler. Of 325 patients, 57 showed signs of puberty during the study (19 from the placebo group, 26 from the FP 50 μg group, 12 from the FP 100 μg group) and were excluded from … [1]: {openurl}?query=rft.jtitle%253DThe%2BJournal%2Bof%2Bpediatrics%26rft.stitle%253DJ%2BPediatr%26rft.aulast%253DAllen%26rft.auinit1%253DD.%2BB.%26rft.volume%253D132%26rft.issue%253D3%2BPt%2B1%26rft.spage%253D472%26rft.epage%253D477%26rft.atitle%253DGrowth%2Bin%2Basthmatic%2Bchildren%2Btreated%2Bwith%2Bfluticasone%2Bpropionate.%2BFluticasone%2BPropionate%2BAsthma%2BStudy%2BGroup.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0022-3476%252898%252970023-X%26rft_id%253Dinfo%253Apmid%252F9544904%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0022-3476(98)70023-X&link_type=DOI [3]: /lookup/external-ref?access_num=9544904&link_type=MED&atom=%2Fpediatrics%2F104%2FSupplement_2%2F389.3.atom [4]: /lookup/external-ref?access_num=000072877800023&link_type=ISI

Treatment of gonadotropin dependent precocious puberty due to hypothalamic hamartoma with gonadotropin releasing hormone agonist depot.

The gonadotropin releasing hormone (GnRH) secreting hypothalamic hamartoma (HH) is a congenital malformation consisting of a heterotopic mass of nervous tissue that contains GnRH neurosecretory neurons attached to the tuber cinereum or the floor of the third ventricle. HH is a well recognised cause of gonadotropin dependent precocious puberty (GDPP). Long term data are presented on eight children (five boys and three girls) with GDPP due to HH. Physical signs of puberty were observed before 2 years of age in all patients. At presentation with sexual precocity, the mean height standard deviation (SD) for chronological age was +1.60 (1.27) and the mean height SD for bone age was -0.92 (1.77). Neurological symptoms were absent at presentation and follow up. The hamartoma diameter ranged from 5 to 18 mm and did not change in six patients who had magnetic resonance imaging follow up. All patients were treated clinically with GnRH agonists (GnRH-a). The duration of treatment varied from 2.66 to 8.41 years. Seven of the eight children had satisfactory responses to treatment, shown by regression of pubertal signs, suppression of hormonal levels, and improvement of height SD for bone age and predicted height. One patient had a severe local reaction to GnRH-a with failure of hormonal suppression and progression of pubertal signs. It seems that HH is benign and that GnRH-a treatment provides satisfactory and safe control for most children with GDPP due to HH.

Prematür Menarş: İki Olgu Sunumu

Unique or repeated prepubertal uterine bleeding without other signs of puberty is a peculiar manifestation of precocious female development Its frequency is less than one tenth that of cases of isosexual precocity in girls Two girls aged 8 years and 6 months and 8 years and 7 months were admitted to our clinic with the complaint of vaginal bleeding in the absence of other signs of precocious sexual development The cases diagnosed premature menarche are presented because of rare presentation in the light of literature Key words: Menstruation Menarche Puberty

Relationship between the thymus and neurochemical changes in the hypothalamus–preoptic area and prefrontal cortex in female rats with delayed puberty

In female rats, aged 55–58 days with delayed puberty due to deficient growth and environmental stress, 5-hydroxyindoleacetic acid levels and serotonin turnover rate in the hypothalamus–preoptic area as well as body weight, body weight gain and relative weight of ovaries, uterus, adrenals and preputial glands were lower while serotonin and 5-hydroxyindoleacetic acid levels in the prefrontal cortex were higher when compared to normal rats with the latest onset of puberty aged 42–52 days. In rats with delayed puberty, multiple regression analysis revealed a significant negative dependence on dopamine turnover in the hypothalamus–preoptic area for body weight gain and, of all organs, for the relative weight of the thymus. A similar negative significant dependence on serotonin turnover rate in the prefrontal cortex was also found for the relative weight of thymus and spleen. The same analysis in the opposite direction revealed a significant negative dependence of 3,4-dihydroxyphenylacetic acid levels and dopamine turnover rate in the hypothalamus–preoptic area as well as serotonin turnover rate in the prefrontal cortex only on thymus weight. After separation of delayed pubertal rats into two groups, based on absolute ovarian weight, the rats in the low ovarian weight range and no signs of puberty exhibited: lower body weight gain, lower body weight, and lower relative weight only of thymus, ovaries and preputial glands in parallel with an increased dopamine turnover rate in the hypothalamus–preoptic area and serotonin turnover rate in the prefrontal cortex compared to the delayed pubertal rats in the high ovarian weight range and early signs of puberty. The results suggest that in rats with delayed puberty: (1) serotonergic activation in the hypothalamus–preoptic area is lower compared to normal puberty rats; (2) dopaminergic activation in the hypothalamus–preoptic area negatively affects body weight gain, thymus weight and initiation of puberty and (3) thymus weight is negatively implicated in dopaminergic activation in the hypothalamus–preoptic area and serotonergic activation in the prefrontal cortex and positively related to ovarian weight and early signs of puberty.

Longitudinal study of behavioral and affective patterns in girls with central precocious puberty during long‐acting triptorelin therapy

The aim of the present study was to evaluate the behavioral and affective characteristics and the changes in psychosocial functioning resulting from precocious puberty in 15 girls with central precocious puberty treated for 2 y using the GnRH agonist long-acting triptorelin, and in 5 untreated girls. After diagnosis of precocious puberty at 6.6-10.4 y of age, height, weight and pubertal development were evaluated at 3-month intervals over 2 y. Semi-structured interviews were carried out with the patient, the parents and the pediatric endocrinologists at 1, 8, 16 and 24 months after diagnosis. Standardized questionnaires (Child Behavior Checklist, Self-esteem Inventory) were administered at 1 and 24 months or 16 and 24 months, respectively. There was a mean 1.5-y delay between the observation of signs of puberty as reported by the parents and the diagnosis of precocious puberty at the first consultation of a pediatric endocrinologist. Before follow-up, all 20 girls were very concerned about physical differences from peers, particularly breast development. During therapy, breast regression to minimal or absent development occurred in 5/15 treated patients, who then no longer felt embarrassed about pubertal development in contrast to the other patients. Fear of sexuality remained obvious throughout the study in most patients. Feelings of loneliness and exemplary behavior were observed and tended to decrease in the treated patients and to increase in the untreated patients. Elevated scores of withdrawal, anxiety/depression and somatic complaints at Child Behavior Checklist were still observed after 2 y. These changes in behavioral and affective characteristics appeared to be related neither to height and weight, nor to development of pubic hair, which progressed in most patients. After 2 y, the physical differences remained a concern for 13 girls and the risk of short adult stature for 6. In summary, some behavioral and affective characteristics and particularities in psychosocial functioning are observed in girls with precocious puberty. During treatment with long acting triptorelin, problematic behavior and functioning decrease slightly, particularly in the few girls showing breast regression to minimal or absent development.

Diurnal rhythm of 17 beta-estradiol secretion throughout pubertal development in healthy girls: evaluation by a sensitive radioimmunoassay.

Puberty is initiated by a nocturnal rise in gonadotropin secretion, which, in boys, results in an increased nocturnal secretion of testosterone. To characterize any similar diurnal rhythm of 17 beta-estradiol in healthy girls, we determined the secretion of 17 beta-estradiol before and during puberty. The study group consisted of 45 healthy girls whose height SD scores ranged from -3.7 to +4.9 compared with Swedish growth reference values. One to 6 profiles of 17 beta-estradiol (7 samples/24 h) were obtained from each girl during puberty and from 21 of the girls before clinical signs of puberty (a total of 76 serum profiles). Serum 17 beta-estradiol concentrations were determined using a modified RIA. The detection limit for the RIA was 1.8 fmol/tube, which corresponded to a serum level of 7.8 pmol/L in extracted serum. It was considered that levels above 50 pmol/L could be determined accurately without extraction. The serum levels of 17 beta-estradiol in prepubertal girls were, in most cases, below the detection limit, except in the morning, when in 17 of the 21 prepubertal girls, serum 17 beta-estradiol levels were just above the detection limit. All girls in early puberty (Tanner breast stage 2) had measurable serum levels of 17 beta-estradiol in the morning, whereas 10 of these 15 girls had levels below the detection limit around midnight. Later in puberty (Tanner breast stages 3 and 4), but before menarche, the diurnal rhythm was more obvious, with high levels of 17 beta-estradiol during the latter part of the night and in the morning. This diurnal rhythm was lost by 1 yr after menarche. There was a high degree of correlation between serum concentrations of 17 beta-estradiol and bone age, whereas there was much less, if any, correlation between 17 beta-estradiol and levels of sex hormone-binding globulin or dehydroepiandrosterone sulfate during puberty. We conclude that the nocturnal rise in gonadotropin secretion during puberty in girls is accompanied by an increased secretion of 17 beta-estradiol in the morning. This diurnal rhythm is lost 1 yr after menarche. Determination of 17 beta-estradiol levels in the morning could be useful in determining the initiation of puberty, whereas determinations in the late evening could provide information on the tempo of puberty.

Preliminary validation of a prediction model for the short-term growth response to growth hormone therapy in children with idiopathic short stature.

A discriminant scoring system, using multivariate analysis, has been developed for pretreatment prediction of responsiveness to a 6-month trial of growth hormone (GH) treatment in short children with subnormal growth velocity, but without GH deficiency. Inclusion criteria included a birth weight above 2.5 kg, height below the 3rd centile for chronological age, height velocity below the 25th centile for bone age, no signs of puberty, a maximal GH response to pharmacological stimulation of above 10 micrograms/l and treatment with GH at a dose of 12-16 IU/m2/week. Children with an increase in height velocity greater than 2.5 cm/year after therapy were considered to be responders. Pretreatment clinical data from 67 patients were employed in a discriminant analysis in order to establish the model. The scoring system developed was as follows: score = -0.4 + 0.92X1 - 0.87X2, where X1 is the height velocity SD score (SDS) for chronological age, and X2 is the bone age SDS for chronological age. This model had a specificity of 96.3% and a sensitivity of 92.5% in predicting the responsiveness to GH. The model has subsequently been applied to a group of 14 patients in order to establish its validity; in this group its sensitivity was 83.3% and its specificity 100%. These preliminary data suggest that the model can be used as a guideline for selecting short, slowly growing, non-GH-deficient children who will respond to short-term GH therapy.

Increase in first morning voided urinary luteinizing hormone levels precedes the physical onset of puberty.

Determinations of serum gonadotropin concentrations by ultra-sensitive methods have improved the diagnosis of pubertal disorders. The onset of puberty can be estimated by measuring serum gonadotropin pulsation, but as this requires serial nocturnal blood sampling, it is not a routine investigation. Gonadotropin measurements in first morning voided (FMV) urine samples could reflect the integrated nocturnal gonadotropin secretion and predict pubertal development earlier than daytime serum measurements. We studied the value of urinary LH (U-LH) measurements in FMV urine with reference to serum LH (S-LH) levels using an ultrasensitive time-resolved immunofluorometric assay in samples from 297 children and adolescents (145 boys and 152 girls, aged 5-15 yr) with known pubertal stages (Tanner 1-5). Stage 1 subjects (prepubertal) were divided into 5 age groups to assess whether there is an increase in LH before clinical signs of puberty can be detected. The correlation between FMV urine and S-LH values was good (r = 0.64; P < 0.0001). The 2 oldest groups of prepubertal subjects (11 and 12 yr) had significantly higher (P < 0.001) U-LH concentrations than the 3 younger groups. This difference was less marked for S-LH. A significant increase in FMV U-LH concentration occurs before the first clinical signs of puberty in a sex-independent fashion. Our data indicate that FMV U-LH measurement is a clinically relevant, noninvasive method for the evaluation of pubertal development, and it may be helpful in the investigation of pubertal disorders.

Suspected sexual abuse in a 10-year-old girl

A white girl, 9 years and 10 months old, was brought to me at the Kinderhospital, Osnabrück, by her mother who had noticed bruises of variable shapes and sizes on her daughter's vulva over the previous 4 months. Ointments had not improved the situation. On examination, there was a sharply delineated, 10·30 mm blue-reddish area on the right labium major, extending to the introitus and looking very much like a bruise (figure). The rest of the introitus was normal; the hymen was intact. There were four pubic hairs, but no other signs of puberty.

Weight Modification Efforts Reported by Black and White Preadolescent Girls: National Heart, Lung, and Blood Institute Growth and Health Study

This study tested four hypotheses: (1) a high percentage of 9- and 10-year-old girls are already trying to lose weight; (2) more white tha black girls are trying to lose weight; (3) more black than white girls are trying to gain weight; and (4) weight modification efforts of preadolescent girls are influenced by factors other than race, such as maternal criticism, body dissatisfaction, and socioeconomic status. Cross-sectional analysis of baseline data on 2379 girls 9 and 10 years of age, which consisted of 1213 black and 1166 white enrollees. Black girls were taller and heavier and showed earlier signs of puberty than white girls but were less dissatisfied with their weight, body shape, and body parts. Approximately 40% of 9- and 10-year-old girls reported that they were trying to lose weight. Of those girls classified in the fourth quartile of body mass index (BMI), approximately 75% were trying to lose weight. After adjusting for BMI, no significant black and white differences in the prevalence of those trying to lose weight were seen, but significantly more black than white girls were trying to gain weight. Multiple logistic regression identified a high BMI, the mother telling her she was too fat, and body dissatisfaction as the major factors associated with trying to lose weight. However, chronic dieting was only associated with a high BMI and the mother telling her she was too fat. An important predictor of girls who were trying to gain weight was being black, along with having a low BMI and the mother telling her she was too thin. Attempts at gaining weight are much more frequent among black preadolescent girls than their white counterparts. No racial difference was found between black and white girls in their efforts to lose weight or to practice chronic dieting. Because approximately 40% of 9- and 10-year-old girls are already trying to lose weight, pediatricians should capitalize on this concern by providing information on proper weight control techniques. Educational efforts should be directed to both the mother and the child, because weight control efforts of preadolescent girls are stimulated by their mothers' admonitions of being too fat or too thin. The high prevalence of dieting among the thinnest adolescent girls also needs to be addressed by pediatricians.

Growth hormone releasing factor and assessment of growth hormone reserve in children

Pituitary somatotrophic reserve was assessed in children with growth delay using clofelin and growth hormone releasing factor (GH-RH). Thirty-four children hospitalized with suspected insufficiency of growth hormone (GH) were examined (22 boys and 12 girls aged 5.3 to 16.2, mean age 11.6±3.2). Bone age lagged behind the chronologic by 4.4+2.1 years, and signs of puberty were absent by the moment of hospitalization in all the children. Clofelin was administered orally in a dose of 0.15 microg/m2 body surface, GH-RH by intravenous jet in a dose of 1 mg/kg. The patients were divided into 3 groups with different response of GH to stimulation with clofelin and GH-RH: group A with a low GH output in both test (the pituitary form); group В with a low reaction to clofelin and normal response to GH-RH (the hypothalamic form); group C with increased level of response to both clofelin and GH-RH (idiopathic dwarfism). Group A included 14 children aged 11.7±2.9. Growth SDS in these children varied from -7.8 to -2.6 (-4.4±1.66). The maximal GH level after clofelin intake was 1.3 ± 1.6 ng/ml and after GH-RH infusion 3.5±2.51 ng/ml in group A. Group В consisted of 7 patients aged 12.0±4.4. Growth SDS in this group varied from -5.6 to 2.5 (- 4.0±1.3). The maximal level of GH in this group was 2.5±2.4 ng/ ml in clofelin test and 15.9±5.4 ng/ml in GH-RH test. Group C included 13 children aged 11.0±4.4, with growth SDS varying from -4.3 to -2.3 (-3.0±0.63). The maximal GH level after clofelin was 15.6±8.2 and after GH-RH 40.8±26.1 ng/ml, this being reliably higher than in group В (U=16.5, p=0.02). Hence, somatotrophic insufficiency was caused by hypothalamic disorders in approximately one-third of our patients.

Investigation of delayed puberty.

Delayed puberty is defined arbitrarily on the basis of statistical consideration, when no signs of puberty have occurred at 2.0 SD (13.4 years in girls and 13.8 in boys) above the mean chronological age for the onset of puberty. The vast majority of these patients have no endocrine abnormality and their pubertal development and growth spurt are simply consequences of primary delay (constitutional delay of growth and puberty (CDGP)) or secondary delay due to a chronic disease of childhood, such as asthma. However, a small proportion may have pathological causes of delayed puberty which must be careful identified as specific management may be required. Associated with delayed puberty, the growth spurt is always delayed which is why the condition is described as delayed growth and puberty. Short stature and lack of sexual development may lead to emotional and social difficulties and in some patients their consequences can persist when 'normal' height and full sexual maturation are attained. Recent data also suggest that a delay in the 'tempo' of pubertal maturation may interfere with the normal bone accretion occurring during puberty, later causing osteoporosis. Such findings suggest that a new approach in delayed puberty may be necessary not only for psychological reasons but also for optimizing bone mass accretion.

Prediction of the outcome of growth hormone therapy in children with idiopathic short stature: A multivariate discriminant analyis

Objective: To identify, with the use of pretreatment clinical data, the children with idiopathic short stature responsive to treatment with growth hormone (GH). Design: Open, prospective study in a university hospital. Subjects: Patients admitted to the study met the following criteria: birth weight at least 2.5 kg, no sign of dysmorphic disease, stature less than the 3rd percentile for chronologic age (CA), linear growth velocity (GV) less than the 25th percentile for bone age (BA), no sign of puberty, maximal GH response to pharmacologic stimulation greater than 10 μg/L, no evidence of organic disease, treatment with daily subcutaneous administration of GH at a dose of 12 to 16 IU/m2 per week. Main outcome measures: Eight pretreatment growth variables and the increase of GV after 6 months of therapy were measured. Children with a change in GV that was greater than 2.5 cm/yr after 6 months of GH therapy were considered responders to GH. Results: We studied 67 patients (44 boys). Forty patients (60%) were responders. With univariate analysis the variables found to have predictive value were GV (z score for gender and CA), bone age (z score for gender and CA), and percentage of ideal body weight. These variables were employed in a multivariate discriminant analysis. Growth velocity and BA showed the best independent discriminant significance in predicting responsiveness to the initial 6 monthsof GH therapy. The obtained equation was as follows: Score = -0.40 + 0.92X1 -0.87X2, where X1 is the GV z value for CA and X2 is the BA z value for CA). Using this scoring system, we obtained a specificity of 96.3% and a sensitivity of 92.5% in predicting responsiveness to GH (chi-square with Yates correction, 48.2; p <0.001). Conclusions: Discriminant analysis may permit the pretreatment prediction of responsiveness to the initial 6 months of GH therapy in short children without GH deficiency. (J PEDIATR 1995;126:905-9)

Prepubertal acne: A cutaneous marker of androgen excess?

Background: Early-onset acne before obvious signs of puberty is an uncommon phenomenon. Objective: The aim of this study was to determine if prepubertal acne is associated with an excess of androgens. Methods: Basal and adrenocorticotrophic hormone-stimulated plasma androgen levels were measured and bone age was determined in 15 children with early-onset acne. Results: A late-onset adrenogenital syndrome caused by 21-hydroxylase deficiency was diagnosed in two children. These children had early pubic hair development and advanced bone maturation. Heterozygosity for 21-hydroxylase deficiency was found in three other children. Conclusion: We recommend hormonal evaluation in children with prepubertal acne, especially those with associated advanced bone maturation and early pubarche.

Two year cumulative incidence of trunk abnormalities in a schoolpopulation in Rotterdam, The Netherlands

We conducted a study of the 2 year cumulative incidence of trunk abnormalities in a cohort of 3,071 11 year old children (1,621 boys, 1,450 girls). The following data were recorded: height, weight, signs of puberty and menarche. Trunk abnormality was assessed in the erect child (asymmetry of shoulders and waistline, imbalance of the trunk, scoliosis, lordosis, kyphosis, swayback and flexibility) and by the forward bending test (FBT) (rib hump or lumbar prominence, persisting scoliosis, kyphosis and deviant lateral aspect). A normal FBT both at baseline and at follow-up was found in 84% of the boys and in 79% of the girls. The 2 year cumulative incidence of an abnormal FBT was 10% in boys and 13% in girls.

Human chorionic gonadotropin: a feasible option for treating undescended testes

In order to shed light on the controversy in the literature about the efficacy of medical treatment of undescended testes, HCG was administered to 73 boys. They were seven month to twelve years old and none of them had puberty signs. Cryptorchidism was unilateral in 75.4%; it was bilateral in 24.6%. Children with retractile testes were excluded from the study. The patients received IM HCG 1500 to 2000 IU/sqm twice a week for 5 weeks. Testicular descent was noted in 23.0% of the undescended testes, often in the first 2.5 weeks of therapy. All children were followed up for at least a year and relapse was observed in 8.3%. Clinical signs of testosterone action faded off shortly after the end of injections. No side effects were apparent by the third month after treatment. We conclude that the administration of HCG is worth of a trial before the surgical approach is contemplated in the management of the cryptorchidism.

10 GnRH AGONIST THERAPY IN TRUE PRECOCIUS PUBERTY SECONDARY TO HYPOTHALAMIC HAMARTOMA (IHH)

Hypothalamic hamartomas, are benigns tumors of central nervous system, related to development of the true sexual precocious puberty, have been more frecuently diagnosed due to improvement of the radiologic technology (computed tomography and MRI scanning). We studied two children with precocious sexual development (Case 1: boy, onset the development of public hair and growth of the penis at 6 months of age; Case 2: girl with breast development and menarche at 6 months. In both patients hypothalamic hamartomas were demonstrated by MRI (Case 2) and CT and MRI (case 1). At the first evaluation we observed enlargenment of the penis (8,0 cm) and a testicular diameter of 2,5 cm in case 1; and b reast stage Tanner II in case 2. Both had a pubertal response to the GnRH stimulation test (100 mg IV), LH 51,4 and 28.3 mUI/ml, respectively and normal levels of DHEAS for age. The children were treated with GnRH analog depot (D-Trp6-GnRH) in dosage of 1.5 mg IM every month for 36 and 18 months respectively. Gonadotropin secretion was inhibited with use of GnRH analog. Physical signs of puberty did not progress futher, without menstrual periods and with height velocity remained between normal range. Laboratory data showed normalization of testosterone level in case 1 (144,5 to 15 ng/dl). We conclude that GnRH analog therapy is efficient in patients with true precocious puberty secondary to hyphotalamic hamartoma.

Pubertal development of the pouch and teats in the marsupial Macropus eugenii

In the female tammar wallaby, Macropus eugenii, which has a highly seasonal breeding pattern, teat eversion and enlargement of the pouch occur at puberty, about 40 weeks after birth. The most obvious sign of puberty is teat eversion: 22 of 23 wild caught, and 23 of 24 captive postpubertal animals had fully everted or everting teats. Full eversion of the teats took on average two to three weeks after puberty. The pouch opening enlarged at puberty, and the rate of enlargement from 2 weeks before puberty to 2 weeks after puberty was significantly greater than the rate before puberty. In a group of pouch young ovariectomized at 5-10 weeks of age, no such changes in either teats or pouch were observed by 46 weeks of age. However, after treatment with oestradiol (0.5 microgram kg-1 body mass), four of five young showed teat eversion within 3-4 weeks. Progesterone (2 mg kg-1) had no effect on inverted teats. In these ovariectomized females oestradiol treatment caused a significant increase in the rate of growth of the pouch opening. During progesterone injections the size of the pouch remained the same. Thus, at puberty the teats and pouch of the tammar wallaby undergo rapid developmental changes and growth. Ovariectomy at an early stage of gonadal differentiation disrupts these normal changes, but treatment of these animals with physiological doses of oestradiol at the age when puberty would normally have occurred can restore teat and pouch maturation. Teat eversion and pouch enlargement can therefore be used as markers for puberty.(ABSTRACT TRUNCATED AT 250 WORDS)

Spermaturia in two normal boys without other signs of puberty

We report spermaturia in two normal boys with testicular volumes of 3 ml and no other signs of puberty. This supports the hypothesis that spermatogenesis can begin before any other signs of puberty and indicates that the definition of start of puberty as testicular volumes of 4 ml or more may be too rigorous.

Neurobehavioural relationships after the onset of puberty.

The behavioural and cognitive development were studied of 68 children with and 259 without minor neurological function (MND) at 14 years, when the majority of children showed three or more physical signs of puberty. MND was differentiated into fine manipulative disability, co-ordination problems, choreiform dyskinesia and hypotonia. The normal group was subdivided into those who had been normal at 12 years and those who had had MND. All types of MND were related to cognitive and behavioural problems. Fine manipulative disability was related to behavioural and cognitive difficulties; co-ordination problems to learning difficulties; and choreiform dyskinesia and hypotonia were related to attention difficulties and school failure, notwithstanding normal IQ. Besides MND, socio-economic class, family adversities and female gender contributed to the development of behavioural and cognitive problems. The behaviour of children with MND at 12 years who were normal at 14 years did not differ from that of normal children.