Makindo Medical Notes

🌱 Puberty is the period of biological maturation when a child transitions into adulthood, gaining the ability for sexual reproduction. It is driven by hormonal signals from the hypothalamus, pituitary gland, and gonads, and while timing varies, the sequence follows predictable stages.

📅 Normal Age of Onset

• Girls: 8–13 years; menarche (first period) usually 12–13 years.
• Boys: 9–14 years; full sexual maturity by 16–18 years.

📊 Tanner Staging (Physical Development)

The Tanner staging system assesses breast, genital, and pubic hair development.

👩 Breast Development (Girls)

• Stage 1: Prepubertal.
• Stage 2: Breast buds (thelarche).
• Stage 3: Breast + areola enlarge, contours not separated.
• Stage 4: Areola/nipple form secondary mound.
• Stage 5: Mature adult breast, smooth contour.

👨 Genital Development (Boys)

• Stage 1: Prepubertal.
• Stage 2: Testicular enlargement, scrotal thinning (first sign).
• Stage 3: Testes enlarge, penis lengthens.
• Stage 4: Penis enlarges (length + girth), glans develops.
• Stage 5: Adult genital size.

🧑‍🤝‍🧑 Pubic Hair (Both Sexes)

• Stage 1: None.
• Stage 2: Sparse, light hair (labia/base of penis).
• Stage 3: Darker, curlier, spreading.
• Stage 4: Adult-type hair, limited area.
• Stage 5: Adult distribution, inner thighs involved.

🧪 Hormonal Axis

• GnRH: From hypothalamus, stimulates pituitary.
• LH & FSH: Act on gonads → oestrogen (girls), testosterone (boys).
• Sex Steroids: Drive breast growth, genital enlargement, hair, voice, and body composition changes.

📈 Sequence of Changes

Girls

1. Breast budding (thelarche) – age 8–13.
2. Pubic hair growth (pubarche).
3. Growth spurt – early, peaks Tanner stage 3.
4. Menarche – ~2–3 years after thelarche (stage 4).
5. Completion – maturity by 16–18.

Boys

1. Testicular enlargement (first sign, age 9–14).
2. Pubic hair follows.
3. Penile enlargement (stages 3–4).
4. Growth spurt – later, ~Tanner stage 4.
5. Completion by ~18 years.

📏 Growth Spurt

• Girls: Earlier (Tanner 2–3), peak ~12 yrs, just before menarche.
• Boys: Later (Tanner 3–4), peak ~14 yrs, continue growing longer → taller final height.

🧠 Psychosocial Impact

• 💭 Body Image: Increased self-awareness; possible distress about changes.
• 😡 Mood Swings: Hormonal + social drivers.
• 👫 Peer Influence: Social comparison, independence, identity formation.

⏳ Variation in Timing

• Precocious Puberty: < 8 yrs (girls), < 9 yrs (boys).
• Delayed Puberty: No signs by 13 (girls) / 14 (boys) → investigate for hormonal imbalance, chronic disease, genetic syndromes.

✅ Conclusion

Puberty is a tightly coordinated hormonal process producing physical, emotional, and social maturation. Recognising normal vs. abnormal patterns (early or delayed) is crucial for timely intervention and reassurance.