The Physiology of Puberty and its Disorders

Abstract

Puberty is a complex process of developmental change regulated by multiple genetic and endocrine controls. Abnormal pubertal development (both precocious and delayed puberty) can cause significant distress to the patient and may in some instances be a sign of life-threatening pathology. Delayed puberty is often due to constitutional delay of growth and puberty, but will also occur in cases of primary gonadal failure and in patients with disorders leading to diminished gonadotropin levels (ie, central nervous system [CNS] tumors). Precocious puberty may occur due to CNS disorders, certain genetic disorders, ectopic gonadotropin secretion or autonomous sex steroid secretion. Treatment is directed toward the underlying pathology, and may include agents to either stimulate or block pubertal development. Health care providers require knowledge of the normal onset of timing and rate of progression of puberty, and must be able to identify patients with abnormal pubertal development, as well as initiate the appropriate laboratory workup.

Acquisition and establishment of the oral microbiota

“…149 The gingival the production of testosterone in male gonads. 151,152 In both male and female individuals testosterone is converted to estradiol, which has high circulating levels and mediates growth spurts and sexual changes during puberty. 153 The hypothalamic-pituitary-adrenal axis is involved in the response to physiological or psychological stressful stimuli by releasing stress hormones, such as cortisol, to help individuals cope with stressful events; responses include mobilization of energy stores, reduction of inflammation, and enhanced immune activity.…”

“…During puberty, 2 hormonal cascades, released by the hypothalamic‐pituitary‐gonadal axis and the hypothalamic‐pituitary‐adrenal axis, play critical roles in the development of important body systems, including the reproductive and immune systems. The hypothalamic‐pituitary‐gonadal axis controls development by secretion of gonadotropin‐releasing hormone: this leads to the release of luteinizing hormone and follicle‐stimulating hormone, which promote the production of testosterone and progesterone in female gonads and the production of testosterone in male gonads 151,152 . In both male and female individuals testosterone is converted to estradiol, which has high circulating levels and mediates growth spurts and sexual changes during puberty 153 .…”

The Effect of Bisphenol A on Puberty: A Critical Review of the Medical Literature

“…Then, a critical time coinciding with the onset of puberty arrives, during which gonadal hormones are no longer able to inhibit the hypothalamus neurosecretory activity. There is a massively elevated release of GnRH and LH-FSH gonadotropins, and the consequent activation of the gonads leads to an increased circulating level of androgens and oestrogens [ 32 , 33 ].…”

Rasmussen’s encephalitis and central precocious puberty. Neuroendocrinological characterization of three cases

“…Puberty is a complex biological process that can be affected by multiple structural, genetic, and environmental factors [4], with an increase in the number and amplitude of peaks of gonadotropin-releasing hormone (GnRH) secretion by hypothalamic neurons mediating its onset [5]. In addition, the sensitivity of the pituitary to hypothalamic stimuli is increased and the response of this axis to the negative feedback of sex steroids is decreased, among other mechanisms, contribute to pubertal onset [6]. Premature pubertal onset involves the anticipated appearance of secondary sexual characteristics (namely bilateral thelarche in girls and testicular volume >4 mL in boys), known as central precocious puberty (CPP), when it occurs before the age of 8 years in girls and 9 in boys [5,6].…”