Endocrine Disorders and Delayed Puberty

Chapter
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Abstract

Abnormal puberty is a common presenting complaint for pediatric endocrinology and gynecology practices. In girls, normal puberty may begin as early as 8 years. Though most Caucasian females develop breast tissue after the age of 8 years, race plays a role in pubertal timing, as it is more common for African American and Mexican-American females to begin puberty at an earlier age. Activation of the hypothalamic pituitary ovarian axis marks the beginning of puberty. Puberty is initiated in the hypothalamus by an increase in GnRH pulsatility and the subsequent development of the neuroendocrine system allows for changes in gonadal hormone stimulatory and inhibitory effects. Gonadotropins secreted by the pituitary in response to GnRH rise gradually. In early puberty, LH increases at night during sleep but it loses its diurnal pattern near menarche. These hormonal changes of the hypothalamus and pituitary influence the ovary, allowing estrogen levels to gradually rise to adult ranges. Rising estrogen levels account for the development of secondary sexual characteristics and ultimately stimulate endometrial growth allowing for menarche to occur.

Keywords

Puberty Pubertal delay Tanner staging Menarche Primary amenorrhea Gonadotropins Estradiol Hypergonadotropic hypogonadism Primary ovarian failure Primary ovarian insufficiency Hypothyroidism Hashimoto’s thyroiditis Hypogonadotropic hypogonadism Hyperprolactinemia 

Abbreviations

ACTH

Adrenocorticotropic hormone

ART

Assisted reproductive technology

BMI

Body mass index

CBC

Complete blood count

CMP

Comprehensive Metabolic Panel

DHEAS

Dehydroepiandrosterone sulfate

FSH

Follicle stimulating hormone

GnRH

Gonadotropin-releasing hormone

HCG

Human chorionic gonadotropin

IVF

In vitro fertilization

LH

Luteinizing hormone

MRI

Magnetic resonance imaging

OCP

Oral contraceptive pill

POF

Primary ovarian failure

POI

Primary ovarian insufficiency

PRL

Prolactin

TBG

Thyroid-binding globulin

TSH

Thyroid stimulating hormone

T4

Thyroxine

TS

Turner syndrome

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Allison Bauman
    • 1
  • Laura Novello
    • 1
  • Paula Kreitzer
    • 2
    • 3
  1. 1.Division of Pediatric EndocrinologyCohen Children’s Medical Center of New York/Long Island Jewish Medical CenterLake SuccessUSA
  2. 2.Division of Pediatric EndocrinologyCohen Children’s Medical Center of New York/Long Island Jewish Medical CenterLake SuccessUSA
  3. 3.Hofstra Northwell School of MedicineHempsteadUSA

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