Precocious Puberty

Abstract

Puberty is an important process in the development of all children during which a series of hormonal changes take place resulting in the appearance of secondary sexual characteristics and an immature child changes into a fertile adult. In addition to these changes, they undergo various other physical and emotional changes also. The normal age of onset of puberty is between 8 and 13 years in girls and 9 and 14 years in boys. There is a common misconception amongst people, that menarche in girls and voice change or appearance of facial hair in boys equates to the onset of puberty. However this is not correct. In girls, the most common first physical sign of puberty is breast development and in boys, the first physical sign is an increase in testicular volume above 3 ml (using Prader orchidometer). The classic pattern of progression of pubertal development in girls is thelarche ( b r e a s t d e v e l o p m e n t ) ’ adrenarche/pubarche (axillary hair and pubic hair) ' menarche (2.53 years after onset of thelarche). In boys the pattern of progression is as follows: testicular enlargement ' adrenarche/pubarche 'penile growth. The above can be documented with the help of sexual maturity rating (SMR) also known as Tanner's Stages (Fig. 1). Voice changes occur in boys at around 10-12 ml testicular volume.