A B C D E F G H I J K L M N O P R S T U V W

PUBERTY DISORDERS

What is a Puberty Disorder ?

Puberty normally occurs between the ages of 12 and 16. In both sexes, a spurt of growth occurs because the body makes more sex hormones androgens in males, oestrogens in females. In boys, voice deepening, muscle development and hair growth (face and pubis) occurs. In girls, breasts and pubic hair develop, and a monthly period (menstruation) begins. Puberty is considered to be delayed if none of the above features are present by the age of 16. It is considered early (precocious) if any of the above features are present below age 11. Neither condition is usually due to a particular disease, although a number of disorders can affect the time that puberty develops. Nevertheless, both conditions can of course cause embarrassment and concern to the child and parents. This alone may justify investigation and treatment.

How does a Puberty Disorder occur ?

Delayed puberty is more usual in males. Boys notice that they are growing more slowly than their schoolfriends, and a lack of muscle development affects physical ability and endurance. In girls, growth problems are often less obvious. It is the lack of sexual development that causes more concern. Precocious puberty is more usual in girls. Growth is speeded up, even from the age of 6 or 7. Although periods may not begin, breasts can certainly develop early. The fast growth of early life leads to bones maturing early. Growth can then stop before the usual age, because the growing parts of the bone fuse. This leads to the child finally being shorter than their friends of similar age.

Why does a Puberty Disorder occur ?

More often than not, both delayed and precocious puberty cannot be traced to a particular gland problem. They are in fact extreme variations of a normal maturing process. Age at puberty tends to be inherited in girls from their mothers, in boys from their fathers. Some children with delayed puberty are found after testing to have other conditions. They may produce too little growth hormone from their pituitary gland (situated behind the root of the nose). Doctors also need to be sure that no hormone or other disorder is present, by doing appropriate tests, particularly for the function of the adrenal gland. Precocious puberty in girls is sometimes due to abnormal production of oestrogens, and in both sexes a certain type of brain tumour (pinealoma) is very rarely present as the cause of the problem.

Treatment Involved for a Puberty Disorder

Doctors often suggest no treatment at all. They will carefully observe changes in growth and sexual maturity. This is done by checking height and weight at regular visits, comparing with standard growth and development charts. X-rays of the wrists and knees help to estimate how much more growth is likely to occur. Blood tests may be performed to check hormone and other chemicals in the blood, and special scans of the brain are able to pick up any glandular (pituitary or pineal) disorder or tumour. It is reassuring to know that if any additional abnormality is found, it can almost always be treated successfully by operation or by drugs. In the usual (common) cases, when no abnormality is identified, the condition is referred to as idiopathic . Treatment then depends on whether the growth problem is sufficient to be embarrassing or socially undesirable. Idiopathic delayed puberty (usually in boys) can be treated by giving androgens by tablet or injection. One can also give the hormones which stimulate the boy's own testes to make androgens. Both approaches are equally successful in stimulating growth and maturity. Depending on the type used, treatment is given for anything between 2 months and 2 years. Idiopathic precocious puberty (usually in the female) can be treated by giving hormones which stop oestrogens from being formed. Special injections (called LHRH agonists) are usually used. They do not reverse development, but hold the level of maturity steady until it is in keeping with girls of similar age.

During Treatment for a Puberty Disorder

There are few side-effects of treating either delayed or precocious puberty. In boys, there may be temporary mild breast swelling. This subsides by itself. The rather rapid maturing brought on by treatment sometimes creates behavioural problems in some boys. This usually settles without special help: just support and understanding.

After Treatment for a Puberty Disorder

The common (idiopathic) forms of delayed and precocious puberty are just variations of normal and not diseases. Treatment does not produce any problems later in life. Sexual function is quite unaffected, and having had either condition does not affect having children. The more unusual causes of delayed and precocious puberty will need to be discussed individually with the doctor, depending on the test results.

Effects on Family of a Puberty Disorder

Parents need to be understanding. Maturing either in height or in sexual development at a different time from other children can be quite embarrassing. It may sometimes be helpful to consult a psychologist.