When did you hit puberty?
Pubertas praecox (premature puberty) and pubertas tarda (delayed puberty)
ICD-10-GM-2020 E30. 0 / ICD-10-GM-2020 E30. 1
What does puberty mean?
Puberty describes the sexual maturity of boys and girls. It covers the period from the first appearance of secondary sexual characteristics to the achievement of full fertility. Puberty can be divided into four phases, thelarche, pubarche, growth spurt and menarche.
The thelarche begins in children between the ages of seven or eight and 14. The subsequent pubarch usually begins between the ages of eight or nine and the age of 15. The growth spurt is around three to ten centimeters per year and occurs around two years earlier in girls than in boys, but around a year after the first signs of puberty appear in both sexes.
The last phase of puberty (in girls) is menarche. It marks the first menstrual period. Strictly speaking, it is an estrogen withdrawal bleeding without ovulation having previously taken place. Menarche usually occurs between the ages of nine and 16, about a year after the growth spurt. It is also typical of puberty that there is a redistribution of the composition of the body tissue. In girls, the fatty tissue is more pronounced, whereas in boys, the muscle tissue.
When exactly a child reaches puberty is individual and depends on various factors such as diet, the environment and the climate. In recent years, a trend towards an earlier onset of puberty has been observed in both sexes. Girls now have their first menarche on average when they are 12.8 years old, while boys' voice breaks on average around 13.5 years.
What does medicine understand by precocious puberty and tarda puberty?
In medicine, precocious puberty is understood as the early onset of puberty with the development of external sexual characteristics before the age of eight.
Puberty tarda, on the other hand, occurs when puberty is delayed. One speaks of puberty tarda if no secondary sexual characteristics have started to develop by the age of 14 or if no menarche has occurred by the age of 16.
What are the symptoms of precocious puberty and tarda puberty?
In girls who suffer from precocious puberty, the breast, pubic hair, armpit hair or both develop significantly earlier than the average of their reference group. Menstruation can also start earlier. In boys, facial, armpit and pubic hair also sets in prematurely. Furthermore, depending on the etiology, the penis grows with or without enlargement of the testicles.
Pre-puberty can also manifest itself in both sexes through increased body odor, acne and behavioral changes. Both girls and boys grow in height during puberty, but the epiphyseal plates (growth plates) close prematurely, which often leads to short stature.
In premature puberty, ovarian or testicular enlargement is also common, but it rarely occurs in isolated early adrenarche (adrenal maturation).
Adolescents who suffer from puberty tarda, i.e. delayed puberty, are often smaller than their peers. Unfortunately, they are sometimes the victims of teasing or bullying and therefore often need help coping with these issues. Boys in particular often suffer from short stature and delayed puberty. This usually manifests itself through psychological stress and embarrassment.
In which types can puberty praecox and puberty tarda be divided?
The precocious puberty can be divided into different forms according to the etiology.
Central precocious puberty is cerebral and is also known as GnRH-dependent precocious puberty. This leads to an overproduction of hormones regulating sex hormone secretion.
The peripheral precocious puberty is also called precocious puberty or GnRH-independent precocious puberty. This form is based on an overproduction of sex hormones without an increase in the regulatory hormones being detectable.
Genetically determined precocious puberty is based on changes in the DNA and occurs in various syndromes.
There are no such classifications in puberty tarda.
What causes precocious puberty and tarda puberty?
When a child reaches puberty is often family-related. Parents whose puberty started rather late often have children for whom this is the same. Birth weight also plays an important role in the onset of puberty. Low birth weight is often associated with early onset of puberty.
Another factor is diet. This has improved significantly in recent decades, which is why scientists suspect that there is a connection here to premature sexual maturity. The phenomenon has been known for decades and continues to do so.
This so-called sexual acceleration affects the entire population. The prevalence of overweight children is also associated with the improved nutritional situation. This also plays an important role in the onset of puberty. Overweight girls, on average, reach puberty earlier than girls of normal weight.
In the case of overweight boys, on the other hand, it is the other way round. This is because the adipose tissue also produces small amounts of estrogen - a female sex hormone - which supports puberty in girls but inhibits it in boys.
The most common cause of delayed puberty in both sexes is a family-related constitutional developmental delay. Affected children show a delayed physical maturation. The doctor can often also use an x-ray of the bones to confirm this as reduced bone age.
In rare cases, organic diseases can also be responsible for delayed puberty. All chronic organ diseases can not only cause underweight and short stature, but also delay the onset of puberty. Likewise, some genetic disorders with changes in the sex chromosomes lead to the absence or delay of puberty.
The most common reason for this is Ullrich-Turner syndrome in girls and Klinefelter syndrome in boys.
Delayed or absent puberty can also be caused by an underactive thyroid, damage to or malposition of the testicles or ovaries. In addition, severe psychosocial stress such as fear of failure or bullying can lead to delayed puberty. Even children who do very intensive physical training such as competitive sports often reach sexual maturity later than their peers who do not.
Who is most often affected by precocious puberty and tarda puberty?
Pre-puberty mostly occurs in children who have premature activation of the higher-level hormone control systems. Acute or chronic brain diseases can also be responsible for the development of premature puberty. Overweight girls have an increased risk of developing precocious puberty.
Puberty tarda usually occurs in children with constitutional developmental delay or in children who suffer from chronic diseases or endocrine disorders. Overweight boys have an increased risk of developing puberty tarda. Even children who are under great stress or who are competitive athletes often do not reach puberty until later.
What are the consequences of precocious puberty and tarda puberty for those affected?
If the children reach puberty earlier, they usually stay smaller in adulthood. This is because the bones stop growing after the early growth spurt. Other possible complications of precocious puberty are psychological abnormalities. In addition to psychological problems, behavior problems and interpersonal difficulties are particularly common. These increase the risk of depression in the following years. Girls are at higher risk than boys.
How exactly puberty tarda affects the affected child depends on the underlying cause. Children who suffer from constitutional developmental delay initially grow more slowly than children of the same age. This can cause a certain level of suffering in those affected. However, the children still reach a normal final size in the end.
When should I see a doctor if I have precocious puberty or tarda puberty?
Both precocious puberty and tarda puberty should definitely be treated by a doctor, as early treatment has a positive effect on the further course. The contact person for this is the pediatrician or the general practitioner, in some cases a referral to a specialist can be made.
You should see a doctor if you have premature puberty if you have severe acne accompanied by greasy hair or excessive vaginal discharge. These complaints usually arise very spontaneously and can take on very different forms. If these symptoms persist over a long period of time and do not go away on their own, you should definitely consult a doctor.
Pre-puberty can also promote the formation of tumors, which is why regular check-ups are mandatory in order to detect and treat cancer at an early stage.
On the other hand, if puberty is severely delayed and therefore puberty tarda is suspected, you should also consult a doctor. This is the case when girls have no menstrual period and boys have significantly delayed testicular and penile growth. The tall stature, which is often associated with puberty tarda, should also be treated as early as possible.
How can precocious puberty and tarda puberty be diagnosed?
To confirm the diagnosis of precocious puberty and tarda puberty, the doctor carries out a physical examination. He also determines the age of the bones using an X-ray of the left hand and performs hormone tests on the blood. In girls, there is usually a gynecological examination, which includes an ultrasound examination of the uterus. Depending on the suspicion, the doctor may order other tests.
When should pre-puberty and tarda puberty be treated?
Treatment should be carried out as early as possible in both precocious and tardial puberty in order to have a positive influence on the course of the disease and to keep the risk of complications as low as possible.
What is the treatment for precocious puberty or tarda puberty?
To treat precocious puberty, the doctor will prescribe certain hormones that can be used to stop the onset of puberty. This is particularly advisable if there are no pathological reasons for the onset of puberty or if there is a suspicion that early development has a strong influence on the height of those affected.
The doctor will stop the regular administration of the puberty-delaying medication again when the affected child has reached adequate mental maturity and the skeletal age is approximately equal to the chronological age. Common drugs for the treatment of precocious puberty are, for example, leuprorelin or triptorelin.
Your doctor will administer it to you directly in the practice by injecting it into the subcutaneous fatty tissue. The hormone depot thus created blocks the release of puberty hormones. The doctor has to refill the hormone depot with a new syringe once a month.
To treat puberty tarda, the doctor must first be aware of the underlying disease. If you have constitutional puberty tarda, treatment is usually not necessary because puberty, although delayed, occurs on its own. In the case of tumors, the doctor orders surgical, radiotherapeutic or chemotherapeutic measures. In both boys and girls, hormone replacement therapy with testosterone or gestagens can usually induce puberty quickly.
Boys usually receive intramuscular injections of testosterone in the form of depot preparations from the age of 13. However, if there is androgen receptor resistance, this treatment will not help. Girls can be treated with low-dose estrogen preparations from the age of 12. A combination of estrogens and gestagens is then given later.
Sometimes the hormones have to be substituted for life in order to prevent possible deficiency symptoms such as bone loss. In any case, an experienced endocrinologist should monitor your hormone therapy in order to avoid side effects such as excessive weight gain, mood swings, physical changes or even cancer.
What should be considered after the treatment?
After the successful treatment of early puberty, individual therapy is essential. This depends on the underlying diseases. In some cases, it can make sense to take certain medications even after the actual treatment. If puberty is to be restarted later, close monitoring and therapy are necessary to achieve normal growth.
You should also have your hormone levels checked regularly. If a tumor was the cause of precocious puberty, regular check-ups are mandatory here too. A lifelong liver-sparing diet may also be necessary. Underlying diseases must continue to be treated even after successful therapy for precocious puberty. Sometimes patients have to take cortisol and progesterone for life.
Even after successful treatment of puberty tarda, follow-up care depends on the underlying diseases. Since many sufferers do not produce enough sex hormones themselves even after treatment, it may be necessary to take hormones into old age or at least until menopause occurs.
This is so important because the lack of sex hormones can reduce fertility and promote the development of serious bone diseases such as osteoporosis. Regular visits to the doctor with blood samples are necessary to check the hormone level and any concomitant diseases.
Can precocious puberty and tarda puberty be prevented?
Pre-puberty occurs when the hormone regulation of the sex hormones is disturbed. Unfortunately there is no way to influence this. Accordingly, it is not possible to prevent early onset of puberty.
Measures to prevent puberty tarda are also not yet known. Most often, the delay in pubertal development occurs regardless of the way of life. In the industrialized countries, malnutrition no longer plays a role as a cause. Science has yet to investigate what influence a poor diet has on the development of puberty.
What does the treatment of precocious puberty and tarda puberty cost?
The costs for the treatment of precocious puberty or tarda puberty are made up of various factors, including the doctor's fee, the materials and medication used and any costs for a stay in hospital.
Does the health insurance company pay for the treatment of pubertas praecox and pubertas tarda?
The health insurance companies usually cover the medically necessary treatment of an illness. If you have any questions about the reimbursement of certain examinations or therapies, it is best to ask your insurance company directly. Our specialists are also happy to assist you with any questions you may have.
About the author: Dr. med. Christiane Brunner
Specialist in General Medicine
As a general practitioner, my main concern is to support you in the truest sense of the word in your everyday life. What can you do to stay healthy? And how do you get well again if you are ill?
I combine traditional medicine with natural healing methods, acupuncture and massage in order to find the therapy that best suits you and your life situation.
It is particularly important to me that I meet you as a person. At eye level, very direct, close and personal - for an uncomplicated togetherness with humor. Because laughter and a small dose of lightness are the best ways to go through life healthily.
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