Puberty-Defining Normal and Understanding Abnormal

Puberty encompasses a multitude of changes as a child transitions to adolescence and adulthood. Over the years, the timing of puberty has seemed to move towards an earlier age than in the past. While genetics plays a role in the timing of puberty, other influences of puberty include race, nutritional status, exposure to endocrine disruptive chemicals, geographic location, psychological factors, and hormonal influences such as leptin and kisspeptin. The typical spectrum of puberty encompasses changes in height, thelarche, a growth spurt, adrenarche, and then menarche. Alterations in the timing of these changes can result in concern and stress for the patient and their family. Prompt attention and careful evaluation for the presence or absence of abnormal puberty is warranted to accurately determine etiology and proper treatment and to prevent long-term sequelae. Consultation with an experienced practitioner can be useful for providers who are not as intimately familiar with the changes of puberty. Once the diagnosis is made, treatment of idiopathic central precocious puberty (CPP) should be accomplished with a GnRH agonist, most commonly leuprolide. Peripheral precocious puberty (PPP) should focus on removing or suppressing the estrogen source, with medication or surgery. When delayed puberty is the source of the problem, treatment is based on finding and treating the underlying cause.