DEPARTMENT OF PEDIATRICS

PUBERTY

PRESENTED BY -:
Presented to
ADITYA KALA (07)
GROUP A (1-32)
 PUBERTY
• Puberty is the phase of life when secondary sexual characteristics
appear and mature , and capability of reproduction is attained.
Deviations from the normal pattern of puberty have major
diagnostic and therapeutic implications.
PHYSIOLOGY
• Puberty involves development of primary (testicular and
penile growth in boys and breast ,ovarian and uterine growth
in girls )and secondary characteristics (pubic and axillary hair
growth , change of voice in boys , acne and axillary odor ).

• Sex hormones (estrogen in girls and testosterone in boys )

play an important role in the development of primary sexual
characteristics, while adrenal androgens are involved in the
development of secondary sexual characteristics in girls.
IN GIRLS IN BOYS
 • Kisspeptin, a hypothalamic peptide is the key regulator of
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puberty. Acting as the ‘on-off switch ’ of puberty , kisspeptin

initiates GnRH pulses. Initially , GnRH pulses occur only
during nights followed by secretion during both day and
night .
• This leads to increase in the level of gonadotrophins, and
thereby, sex hormones.
• LH is better indicator of pubertal status compared to FSH.
• Pulsatile secretion of GnRH makes basal gonadotrophin
levels an unreliable indicator of pubertal status .
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• The hypothalamic - pituitary – gonadal axis is under feedback control.

Thus secretion of LH is inhibited by testosterone and estrogen
produced by Leydig cells and theca cells, respectively.
• Inhibin produced by the Sertoli and granulosa cells inhibits FSH
production.
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PATTERNS OF PUBERTAL DEVELOPMENT
• The pattern of pubertal development is different in girls and boys .
• Puberty starts around the age of-
10 years in girls (range 8-12 years) and completed over 5 years.
• Events – Thelarche (breast enlargement)

Pubarche (development of pubic hair)

Menarche ( onset of menstrual cycles)

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• Breast development may be asymmetrical in initial phase.

• Menarche usually occurs 2 years after thelarche usually during
stage III and IV .
• Pubertal development is closely linked to remaining growth
potential of the child. Thus a girl is expected to gain around 20cm
from breast stage II development and 5-8 cm after achieving
menarche.
• Discordant pubertal development (menarche within one year of
thelarche) suggests a hyper estrogenic state with withdrawal
bleeding.
 • In boys, puberty starts with testicular enlargement at 11.5 years
(range 9-14 years).
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• This is followed by penile enlargement and pubarche ; spermarche

occurs by 14 years.
• Peak growth velocity in boys correlates to testicular volume of 10ml.
ASSESSMENT OF PUBERTY
• The stage of pubertal assessment is assessed using Tanner staging
system.
• Breast development beyond Tanner II in girls and testicular volume
greater than 4ml indicates onset of puberty .
• Maximum growth spurt occurs during early puberty in girls(Tanner
II-III) compared to boys where it occurs late (Tanner III-IV).
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Comparison of pattern of pubertal development

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SEXUAL MATURITY RATING (1-5) IN
GIRLS
• STAGE I—prepubertal
• STAGE II – early puberty
• STAGE III — mid puberty
• STAGE IV – advanced puberty
• STAGE V – adult type
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SEXUAL MATURITY RATING (1-5) IN
BOYS
THANK YOU