Understanding puberty disorders

In her latest online article, Professor Sze May Ng OBE gives us her insights into puberty disorders. She talks about the common signs and symptoms, how to differentiate between normal puberty and puberty disorders, medicals test used to diagnose puberty disorders, treatment options and the long-term effects or complications.

What are the common signs and symptoms of puberty disorders in children?

Let's begin by discussing the typical progression of puberty. Puberty marks the phase when the body undergoes transformations, transitioning into its adult form. Typically, girls tend to initiate this process a bit earlier than boys. In girls, the onset of puberty typically ranges from around 8 to 13 years of age, while for boys, it's generally between 9 and 14. So, when you inquire about common puberty-related issues, we're essentially referring to situations on either end of this spectrum. For instance, there's precocious puberty, which involves the development of pubertal signs before the age of 8 for girls or before the age of 9 for boys. On the other hand, there's delayed puberty, where individuals do not exhibit any signs of puberty, such as physical changes, until they reach 13 or older for girls and 14 or older for boys.

Understanding the baseline of typical puberty timings is crucial. Now, the early indicators of puberty that girls typically experience include the emergence of breast buds, which are the initial signs of breast tissue development, and the growth of pubic hair. In boys, it's mostly the growth of pubic hair and  testicular enlargement, though it might not be as noticeable. Facial hair, moustaches, beards, underarm hair, and a deepening voice are changes that occur later in the course of puberty, so boys shouldn't be overly concerned if they haven't experienced these yet.

Furthermore, softer signs of puberty, like body odour, greasy hair and facial acne, can manifest a bit earlier than the more prominent physical characteristics.

How can I differentiate between normal puberty and the puberty disorder in my child?

If you know what normal puberty looks like, it's important to understand that the time it takes can be different for everyone, whether you're a boy or a girl. In girls, the average duration for puberty to run its course is typically around three years. This covers the span from the initial appearance of breast buds and the development of pubic hair to the commencement of regular menstruation or period cycles. However, this timeframe can fluctuate, ranging from two to five years, given that it follows a spectrum and it can vary for individual to individuals. Similarly, in boys, the process can take anywhere from three to five years.

In cases where you have concerns about anything that deviates from the usual course of puberty, like precocious puberty or delayed puberty, it becomes crucial to seek prompt medical attention. In such situations, it's advisable to consult a doctor who will likely refer you to a paediatric endocrinologist—a specialist in children's hormone-related issues, such as myself.

What medical tests are used to diagnose puberty disorders in adolescence?

It depends on the situation. For instance, GPs might perform tests like LH and FSH, but these tests are not particularly helpful for determining whether a child has started or delayed puberty because they provide a snapshot of hormone levels. These tests are typically used when there's a suspicion of ovarian or testicular issues.

The tests that hormone specialists need to carry out usually require a day at the hospital. It's often an LHRH stimulation test, which takes around two hours and doesn't require fasting. This test evaluates various hormone levels and assesses the signals sent by the pituitary gland to activate the ovaries or testes. So, it involves multiple hormone assessments but is typically done as a day procedure.

What are the treatment options available for managing puberty disorders?

It all depends on the type of puberty issues we've talked about. If a child is experiencing precocious puberty, which means puberty starting too early, in addition to the LHR stimulation test, we might need to perform a bone age assessment to see how much bone growth has occurred. Sometimes, a brain MRI scan is necessary to make sure that nothing in the brain is triggering early puberty. At other times, a pelvic ultrasound might be done to check if the ovaries are ready for ovulation or if the uterus is prepared for menstruation.

So, these are some of the other tests we might use. If it's confirmed to be precocious puberty, the usual treatment involves LHRH analogue injections to delay the pubertal progression. The frequency of these injections, whether monthly, every three months, or every six months, should be discussed with a hormone specialist. This treatment is crucial to safeguard a child's final adult height and ensure they don't enter puberty too early when their brain isn't yet mature.

On the other hand, the treatment for delayed puberty is different. If a child hasn't shown any signs of puberty by the age of 13 for girls or 14 for boys, investigations are needed to determine if the signals from the hypothalamic pituitary gonadal axis are functioning properly. If it's confirmed that everything is working but it's just delayed, a referral to a paediatric endocrinologist or hormone specialist is typically made. They can initiate treatment to kickstart puberty using hormones like oestrogen and testosterone, but this is usually a short-term solution to jumpstart the process. It's crucial to discuss and monitor this with a paediatric endocrinologist in all cases.

In many instances of delayed puberty, no treatment is needed, as it's often due to a natural variation called "constitutional delay of puberty," which simply means it's a bit late to start, and no intervention is required. The most important step is to have a discussion with a paediatric endocrinologist to determine the best course of action.

Are there any long-term effects or complications associated with untreated poverty disorders?

As mentioned earlier, in the case of untreated precocious puberty, the long-term consequences can lead to a reduced final adult height. This is a significant concern.

Another critical consideration is the psychological impact on young individuals who enter puberty too early. When this happens, they may struggle with immaturity, experience early periods, or mood swings, which can affect their learning and overall well-being. On the other hand, in cases of delayed puberty, there's a psychological aspect to consider as well. For these adolescents, not keeping pace with their peers in terms of physical development can be especially troubling. This is particularly noteworthy in boys who may feel upset about not developing as quickly as their friends, many of whom have facial hair and look more mature. It's important to emphasise that these individuals might benefit from counselling or psychological support in cases of delayed puberty. In most instances, this emotional aspect should be discussed with a paediatric hormone specialist.

Professor Sze May Ng OBE is a distinguished consultant paediatric endocrinologist and consultant paediatrician with over 20 years of experience.

She has written 3 books , one about her journey as an autism mother and discusses a wide range of resources and practical advice to help families.

Another book about management of type 1 diabetes and another called Me and My Hormones can be found here.

You can schedule an appointment with Professor Ng on her Top Doctors profile.