Adolescence

Adolescence

Growth and Development

Two changes –
1. Sexual maturation
2. Increase in body size.
The growth spurt in boys occurs between ages 13 and 15½ years
The growth spurt in girls occurs between ages 11 and 13½ years
boys are heavier and taller than girls.
Bones, muscles, and all the organs grow except the lymphatic system, which decreases in size,
brain, reaches its maximum weight during adolescence.
Sexual changes - In boys,
1. Growth of the scrotum and testes,
2. Lengthening of the penis and growth of the seminal vesicles and prostate gland
3. Pubic hair appears. Hair grows on the face and in the underarms about 2 years after it starts to appear in the pubic area.
4. First ejaculation usually occurs between ages 12½ and 14, about 1 year after the penis begins to lengthen.
Breast enlargement (gynecomastia) on one side or both is common in young adolescent boys but usually disappears within a year.
In girls,
1. Breast budding,
2. The growth spurt. Height and weight increases
3. Pubic and underarm hair appears.
4. first menstrual period generally comes about 2 years after the breasts start to enlarge. Height increases most before menstruation begins.

Delayed Sexual Maturation

Delayed sexual maturation is a delay in sexual development.
Chromosomal abnormalities - Turner's syndrome in girls -Klinefelter's syndrome in boys.
disorders affect hormone production.- tumor in pituitary gland or hypothalamus can lower the levels of gonadotropin
Chronic illnesses-diabetes mellitus, kidney disease, and cystic fibrosis
Symptoms and Diagnosis
A short height (short stature) may indicate delayed maturation in both boys and girls.
Symptoms of delayed sexual maturation in boys

1.      lack of testicular enlargement by age 13½,

2.      lack of pubic hair by age 15,

In girls,

1.      lack of breast development by age 13,

2.      more than 5 years from the beginning of breast growth to the first menstrual period,

3.      lack of pubic hair by age 14,

4.      Failure to menstruate by age 16.

Laboratory tests

1.      x-rays of the hand and wrist -used to estimate bone maturity

2.      X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans may show abnormalities in the brain

3.      Hormone levels- FSH,LH,Testosterone,estrogen,TSH,T3,T4

4.      Tests for diabetes mellitus, anemia, renal, hepatic functions

5.      chromosomal analysis

Treatment

depends on its cause.
genetic cause can't be cured, replacing hormones may help secondary sexual characteristics develop.
In some cases, surgery may be needed.

Precocious Puberty

Precocious puberty is sexual maturation that begins before age 8 in a girl or before age 10 in a boy.
In true precocious puberty, the sex glands (ovaries or testes) mature and a child's outward appearance becomes more adult. Pubic hair grows, and the child's body shape changes.
In pseudo precocious puberty, only the outward appearance becomes more adult, while the sex glands remain immature.
True precocious puberty is two to five times more common in girls than in boys.

Causes

early release of sex hormones (gonadotropin) from the pituitary gland; these hormones affect the sex organs.
A hormone-secreting tumor in the pituitary
An abnormality in the hypothalamus
Most girls under 4 years of age with true precocious puberty have a brain abnormality.
Reason may not be found in 40% boys and 80% girls
In pseudo precocious puberty, high levels of male sex hormones (androgens) or female sex hormones (estrogens) are produced; the cause may be a tumor in the adrenal gland or in a testis or ovary. These hormones do not cause the sex glands to mature but do cause a child to look more like an adult.
McCune-Albright syndrome is a condition that causes pseudoprecocious puberty with bone disease, irregular skin pigmentation (café-au-lait spots), and hormonal abnormalities.

Symptoms and Diagnosis

In both true precocious and pseudo precocious puberty
A boy develops facial, axillary, and pubic hair.
Penis lengthens
Appearance becomes more masculine.
A girl may start to have menstrual periods,
She may develop breasts, pubic hair, and axillary hair.
In boys and girls, body odor changes,
Acne may appear.
Height increases rapidly but stops at an early age. Therefore, the final height is shorter than had been expected.
In true precocious puberty, the testes or ovaries enlarge to adult size
But not in pseudo precocious puberty
Diagnostic tests
Measuring blood hormone levels
X-rays of the hand and wrist to estimate bone maturity.
Ultrasound examination of the pelvis and adrenal glands
Computed tomography (CT) or magnetic resonance imaging (MRI) of the brain to see tumors in the, hypothalamus, or pituitary gland.

Treatment

In true precocious puberty-, histrelin (a synthetically made gonadotropin-releasing hormone) stops the pituitary gland from producing gonadotropin.
Pseudo precocious puberty - inhibit the action of the sex hormones with drugs.
Antifungal agent ketoconazole reduces the levels of testosterone circulating in the blood in boys
Testolactone reduces the levels of estrogen in adolescents who have McCune-Albright syndrome.
When a tumor is responsible for true precocious or pseudo precocious puberty, removing it may cure the condition.