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Precocious and Delayed Puberty Revisited
The subject of puberty has traditionally been fraught with questions and controversies among endocrinologists, gynecologists, pediatricians, internists, and parents in large part fueled by insufficient reproducible data. The controversies concern theories about the onset of normal puberty as well as etiologies of variations of pubertal development, both early and late onset of puberty. The correct recognition as well as management of these disorders has generated a great deal of interest resulting in novel investigations over the past decade. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - April 26, 2024 Category: Endocrinology Authors: Robert Rapaport Tags: Foreword Source Type: research

Abnormal Puberty Revisited: A Practical Approach
Given the prevalence of issues related to puberty in the public and social media as well as newer research findings, it is an appropriate time to review the ways pubertal changes may present at any age. Appropriate management of these children often involves follow-up clinical assessment with varying and sometimes minimal requirements for laboratory assessment, especially at initial presentation. Thus, this issue of Endocrinology and Metabolism Clinics of North America aims to present a practical approach to children presenting with findings of early or late pubertal development. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - April 26, 2024 Category: Endocrinology Authors: Peter A. Lee, John S. Fuqua Tags: Preface Source Type: research

Precocious and Delayed Puberty Revisited
ENDOCRINOLOGY AND METABOLISM CLINICS OF NORTH AMERICA (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - April 26, 2024 Category: Endocrinology Authors: Peter A. Lee, John S. Fuqua Source Type: research

Copyright
Elsevier (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - April 26, 2024 Category: Endocrinology Source Type: research

Contributors
ROBERT RAPAPORT, MD (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - April 26, 2024 Category: Endocrinology Source Type: research

Contents
Robert Rapaport (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - April 26, 2024 Category: Endocrinology Source Type: research

Forthcoming Issues
Update on Endocrine Disorders During Pregnancy (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - April 26, 2024 Category: Endocrinology Source Type: research

Hormone Therapy During Infancy or Early Childhood for Patients with Hypogonadotropic Hypogonadism, Klinefelter or Turner Syndrome
Managing patients unable to produce sex steroids using gonadotropins to mimic minipuberty in hypogonadotropic hypogonadism, or sex steroids in patients with Klinefelter or Turner syndrome, is promising. There is a need to pursue research in this area, with large prospective cohorts and long-term data before these treatments can be routinely considered. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - March 8, 2024 Category: Endocrinology Authors: Elodie Fiot, Juliane L éger, Laetitia Martinerie Source Type: research

Normal Puberty
Puberty is characterized by gonadarche and adrenarche. Gonadarche represents the reactivation of the hypothalamic-pituitary-gonadal axis with increased gonadotropin-releasing hormone, luteinizing hormone, and follicle-stimulating hormone secretion following the quiescence during childhood. Pubarche is the development of pubic hair, axillary hair, apocrine odor reflecting the onset of pubertal adrenal maturation known as adrenarche. A detailed understanding of these pubertal processes will help clarify relationships between the timing of the onset of puberty and cardiovascular, metabolic, and reproductive outcomes in adulth...
Source: Endocrinology and Metabolism Clinics of North America - March 4, 2024 Category: Endocrinology Authors: Kanthi Bangalore Krishna, Selma F. Witchel Source Type: research

Females with Breast Development before Three Years of Age
Breast development in a girl 3  years of age or younger is a commonly encountered scenario. Nearly all of these cases will either regress or fail to progress during follow-up, confirming a diagnosis of premature thelarche (PT). Studies show that these girls will have onset of true puberty and menses at a normal age. The authors present evidence that laboratory testing, particularly basal and gonadotropin hormone-releasing hormone –stimulated gonadotropin levels, will show overlap between girls with PT and the rare patients with the onset of central precocious puberty before age 3, mainly of whom have hypothalamic hamart...
Source: Endocrinology and Metabolism Clinics of North America - March 4, 2024 Category: Endocrinology Authors: Paul Kaplowitz, Peter A. Lee Source Type: research

Diagnosis of Central Precocious Puberty
A thorough history and physical examination including Tanner staging and growth assessments can guide differential diagnosis and aid in the evaluation of precocious puberty. Basal luteinizing hormone levels measured using a highly sensitive assay can be helpful in diagnosing central precocious puberty (CPP). Brain MRI is indicated with males diagnosed with CPP and females under the age of 6 with CPP. As more information becomes available regarding the genetic etiologies of CPP, genetic testing may preclude the need for imaging studies and other hormonal testing, especially in familial cases. (Source: Endocrinology and Meta...
Source: Endocrinology and Metabolism Clinics of North America - March 4, 2024 Category: Endocrinology Authors: Kanthi Bangalore Krishna, Lawrence A. Silverman Source Type: research

Diagnosis, Treatment, and Outcomes of Males with Central Precocious Puberty
Central precocious puberty (CPP) among males is less frequent than among females but more likely to have an underlying pathologic cause. Diagnosis of CPP is often straightforward among males because increased testicular volume, the first sign of puberty, can be verified although careful central nervous system (CNS) assessment is generally necessary. Treatment with gonadotropin-releasing hormone agonist (GnRHa) is indicated, given in conjunction with any therapy needed for CNS lesions. Monitoring of treatment usually can consist of evaluating growth and physical puberty and with testosterone levels as the only lab data. Sho...
Source: Endocrinology and Metabolism Clinics of North America - February 29, 2024 Category: Endocrinology Authors: Ren ée Robilliard, Peter A. Lee, Lisa Swartz Topor Source Type: research

Premature Pubarche
Premature pubarche (PP) is a common and usually benign variant of normal puberty most often seen in 5-year-old to 9-year-old children. Some providers routinely order laboratory testing and a bone age to try to rule out other diagnoses including nonclassic congenital adrenal hyperplasia and gonadal or adrenal tumors. I review the natural history of PP and studies which suggest that without clinical features such as rapid growth and progression or genital enlargement, it is unlikely that a treatable condition will be found. Therefore it is recommended that patients with PP not undergo testing unless there are red flags at th...
Source: Endocrinology and Metabolism Clinics of North America - February 28, 2024 Category: Endocrinology Authors: Paul B. Kaplowitz Source Type: research

Isolated Vaginal Bleeding Before the Onset of Puberty
Isolated vaginal bleeding before the onset of puberty is a rare presentation of isosexual precocity. In most cases, isolated vaginal bleeding without an abnormal genital examination is self-limited with resolution usually within 1 to 3 episodes. Watchful waiting is appropriate in most patients who do not have persistent bleeding, other signs of puberty, or signs/symptoms of an underlying etiology. Workup for patients with concerning features may include puberty hormone levels and/or transabdominal and transperineal ultrasound. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - February 23, 2024 Category: Endocrinology Authors: Natalie G. Allen, Paul Kaplowitz Source Type: research

Presentation and Care for Children with Peripheral Precocious Puberty
Peripheral precocious puberty (PPP) refers to the early onset of sexual maturation that is independent of central nervous system control. The extensive differential diagnosis includes congenital and acquired causes. Presenting features depend on which class of sex steroids is involved, and diagnosis rests on hormonal and, if indicated, imaging and/or genetic studies. Effective treatment exists for nearly all causes of PPP. Ongoing research will advance our therapeutic armamentarium and understanding of the pathophysiologic basis of these conditions. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - February 20, 2024 Category: Endocrinology Authors: John S. Fuqua, Erica A. Eugster Source Type: research