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PUBERTY

ENDOCRINOLOGY DIVISION
DEPARTMENT OF CHILD HEALTH
MEDICAL SCHOOL
UNIVERSITY OF SUMATERA UTARA

Whats wrong with me ????

What is Puberty?
Puberty, from the Latin word: Pubertas
age of maturity refers to the stage of transition
from the sexually immature child to the potentially
fertile adolescent, during which secondary sexual
characteristics appear and the ability to procreate is
established.

Close interaction between the hypothalamic-pituitarygonadal axis (HPG axis) & adrenal cortex.

HPG axis Sexual characteristics

(breast, increase in testicular and penile


size, menarche.
Adrenal androgen Sexual hair
(pubarche), acne, axillary odour

Understanding of regulation and progress of


puberty is crucial for evaluation and
management of pubertal disorders

HYPOTHALAMIC-PITUITARY-GONADAL (HPG)
AXIS
Peripheral signals
(Leptin, Ghrelin)

Central signals
(GABA, NPY, Glutamate)

Kisspeptin
GnRH
Pituitary
FSH

LH

Ovary

Testis
Ley

Gran

Ser

Testosterone

LH

Inhibin

The

Estradiol

HORMONAL CHANGES IN
PUBERTY
Increased GnRH secretion the first identifiable

event of puberty.
At the onset of puberty LH pulse secretion are
evident only during the night, approximately 1-3
years before any external signs of puberty are
manifest. Mid puberty LH pulse secretion appears
during the day. Adulthood The day/night pattern
disappears
Increase LH levels as much as 25x during puberty as
compared to FSH (2,5 fold) LH level Better
indicators of pubertal status compared to FSH levels.

Serum Gonadotropin and sex steroid levels in


relation to Sexual Maturity Rating (SMR)
BOYS
SMR
Stage

LH (IU/L)

0,1 0,3 0,4 2,3

0,5 1,8 0,3 1,6 1,5 6,3

FSH
(IU/L)

0,1 0,9 0,1 2,8

0,3 3,0 0,4 5,0 0,6 5,0

Testoster
one
(ng/dL)

<3 10

18 150

100
320

220
620

350
970

GIRLS
SMR
Stage
LH (IU/L)

0,1 0,2 0,1 4,1

0,5 4,3 1,0 4,0

0,8
12,1

Hormonal changes..
Hormones:
-Gonadotroin
-Sex Steroid
-Growth
hormone

Physical:
-Reproductive system
-Secondary sex
characteristics
-Growth spurt

Final Height
Maturation reproductive
system
Fertility

Influencing factors
1. Genetics : 50 80% of variation in

pubertal timing
2. Environmental factors e.g. nutritional
status
3. Leptin Regulates appetite and
metabolism through hypothalamus.
Permissive role in reegulation of timing of
puberty.
4. Adrenarche : development of pubic and
axillary hair, body odour, and acne

What is the age of onset of


puberty ?

Females

years
Males

: 8 13

: 9 14 years

Physical Changes of Puberty


Estrogen
*GIRLS*
Stimulates growth of the uterus

- Corpus/Cervix ratio
Pepubertal < 1 Pubertal = 1
- Endometrium proliferation
Stimulates endometrial growth
Stimulates cervical mucus secretion
Labia Majora : Pigmentation, vascularisation, erotisation
Enlargement of clitoris
Vagina: - Mucosal thickening
-Changes in Epithelial cell ratio (superficial, intermediate,
parabasal)
- glicogen deposit pH , fungal infection

Breast buds (Thelarche) First

Manifestation, followed by the development of


pubic hair six months later and then axilla hair
Sexual Maturating Scale (Tanners staging).
Pubertal growth spurt early in puberty and

grow rapidly in breast stage 2-3, averaging 8,5


cm/yr.
Menstrual cycles usually commence around 2-

2,5 yeears after thelarche, usually in Tanner


stage 3-4 og breast development.

Physical Changes of Puberty


*BOYS*
Testosterone:
Growth of male genital organs, pubic hair,
and sebaceous glands.
Testosterone and estrogen responsible
for growth spurt, directly or indirectly by
increasing GH production.
Both hormones stimulate epiphyseal
growth and maturation, though estrogen is
ultimately responsible for epiphyseal
fusion.

Enlargement of testes ( 4 ml in volume or

2,5 cm length) First Manifestation of


puberty in boys.
Followed by penile growth with thickening
and pigmentation of the scrotum.
Pubic hair appears around 1 year after
pubertal onset and body odour develops.
Axillary hair and facial hair develop towards
mid-puberty, after 14 years of age.

4 ml

Siklus Menstruasi
Menstruasi: Terjadi akibat interaksi hormon yang

dihasilkan oleh hipotalamus, hipofisis dan


ovarium.
Data Third National Health and Nutrition

Examination Survey (NHANES) umur rata-rata


menarche remaja Amerika adalah 12,43 tahun.
Walaupun hampir 90% remaja mencapai
menarche pada stadium Tanner 4.

Lamanya siklus menstruasi: jumlah hari mulai

hari pertama keluarnya darah sampai


menstruasi pada siklus berikutnya.
Rata-rata lama siklus 21-35 hari, rata-rata

keluarnya darah 3-7 hari dan kehilangan darah


30-40 ml per hari.
Siklus menstruasi dibedakan menjadi 2 fase:

fase folikular atau proliferatif (fase estrogen)


dan fase luteal atau sekresi (fase progesterone)

Kadar hormon & perubahan endometrium selama


siklus menstruasi

Any