Blog

What is puberty?

Adolescence is the period of transition from childhood to adulthood.

It is characterized by the appearance of secondary sex characteristics (breasts, hair growth, etc.) and the acquisition of reproductive capacity. Puberty normally begins between 8 and 13 years of age in girls and 9 and 14 years of age in boys.

During puberty, we have two hormonal phenomena: adrenarche and puberty. Both must begin at the right time.

What is precocious adrenarche?

The adrenal glands are two small glands, above the kidneys.

They secrete many important hormones for our health (e.g. regulation of blood pressure, stress, etc.). In addition, they also secrete androgens.

Normally, after the ages of 8 and 9 in girls and boys respectively, the adrenal glands significantly increase the production of androgens. This phenomenon is called adrenarche.

With adrenarche we have:

• Occurrence of bad breath
• Hair growth in the armpits and pubis (later on the face for boys)
• Acne

They do not necessarily all appear at once. For example, a child may experience a change in smell once or twice, before this phenomenon begins to become more common and after months develop pubic hair.

When any of these (bad breath – hair growth – acne) appears before the age of 8 in girls and 9 in boys, the child should be checked. As parents, you may also notice behavioral disorders.

How is early adrenarche tested?

Before any laboratory test is performed, a clinical examination by a pediatric endocrinologist is very important to determine whether the child has early androgen secretion, precocious puberty (see below) or both.

A laboratory test is then performed that includes:

• Bone age: X-ray of the left arm that provides information about the influence of hormones on development.
• Blood test for hormones.
• Often imaging of the organs that secrete hormones. (e.g. imaging of the adrenal glands)

Treatment:

In girls, the most common cause is Idiopathic Precocious Adrenarche, meaning that no pathological cause is found.

However, testing is necessary to rule out serious diseases that require immediate treatment.

In boys, a pathological cause is more often hidden. In addition to testing, to rule out a serious diagnosis, monitoring the child is important, because precocious adrenarche can affect the onset of puberty and the child’s health later.

What is precocious puberty?

Puberty normally begins between 8 – 13 years of age in girls and 9 – 14 in boys.

The hypothalamic-pituitary-gonadal axis is activated, resulting in the start of the gonads, that is, the ovaries in the girl and the testicles in the boy. The gonads then secrete the sex hormones, estrogen in the girl and testosterone in the boy, thus gradually changing the child’s body.

Essentially, it all starts when the hypothalamus, an area of ​​the brain, secretes the hormone GnRH, which stimulates the pituitary gland.

The pituitary gland in turn secretes two other hormones, LH and FSH, which awaken the gonads and gradually put them into operation.

How do we understand that puberty has begun?

In girls, the first sign of puberty is breast enlargement, which may be accompanied by pain.

Later, they experience the pubertal leap, that is, they grow taller quickly. Finally, the first menstrual period comes about 2 years after the onset of puberty. Many mothers do not realize the onset of puberty and are therefore surprised when they suddenly see their child’s developed breasts or the first period.

In boys, in response to pituitary hormones, the testicles grow. It is the first sign that the doctor will assess.

It will take time before we see the result of a greater secretion of testosterone: penis enlargement, accelerated growth rate, change in the young man’s voice.

When do we have precocious puberty? What do we do?

The key ages are 8 years old in girls and 9 years old in boys. If a sign of puberty is detected before this age (breast development or testicles larger than children’s), then the child should be investigated.

Investigation is required to rule out a pathological cause of early breast development/testicular enlargement and, if such a cause is found, to treat it immediately.

The pediatric endocrinologist will take a detailed family and personal history, examine the child and finally, recommend a laboratory test. This test usually includes:

• Bone age: X-ray of the left arm that provides information about the influence of hormones on growth.
• Blood hormone test, possibly with an LHRH test. (determination of a (or not)
• Frequently imaging the organs that secrete hormones. (e.g. MRI of the hypothalamus and pituitary gland, ultrasound of the uterus and ovaries)

Treatment:

Depending on the underlying cause that causes the child’s early development, therapeutic intervention will be needed or not.

At the same time, your doctor will probably discuss with you the use of pharmaceutical inhibition of puberty.

Practically it is done with an intramuscular injection every month or three months to stop the development of puberty… as if we put the pubertal axis to sleep for the period that the treatment is used.

What you should discuss with your therapist to decide (together!) on the indication for puberty inhibition:

Towards the end of puberty, a child’s growth (height growth) stops. The bones of children with precocious puberty mature and close earlier, resulting in the child being shorter than expected.

Precocious puberty can also cause emotional and social problems for these children, who are ahead of their peers in terms of sexual maturity.