Hi, this is Tom, and in this episode, I'm going to be going through delayed puberty.

And you can find notes at 0.0.5 and in the 0 to Finals Pediatrics book.

And you can find flashcards and questions at members.0.0.0.0.com. So let's jump straight in.

Let's start by talking about normal puberty. Puberty typically starts at aged 8 to 14 in girls

and 9 to 15 in boys.

Puberty typically takes about four years from start to finish.

Girls have their pubertal growth spurt earlier in puberty than boys.

In girls, changes occur in roughly the following order.

It starts with development of the breast buds,

then development of pubic hair, and finally the onset of menstrual periods about two years after the start of puberty. In boys, changes occur in roughly the following order.

Initially, enlargement of the testicles, then enlargement of the testicles, then enlargement of the penis,

then darkening of the scrotum, development of pubic hair, and finally deepening of voice.

The tanner scale can be used to determine the stage of pubertal development based on examination findings of the sex characteristics.

Next let's talk about hypogonadism.

Hypogonadism refers to a lack of the sex hormones, estrogen and testosterone, that rise during puberty.

These hormones are controlled by the gonadotropins, follicle-stimulating hormone, fsh, and

lutonizing hormone, LH, which are released by the anterior pituitary gland.

A lack of estrogen or testosterone results in delayed puberty.

This occurs either by hypogonadotropic hypogonadism, where there's a deficiency of LH and FSAH, or hypergonadotropic hypogonadism,

which is where there's a lack of response to LH and FSAH by the gonads, the testes or the ovaries.

Let's talk in more detail about hypogonadotropic hypogonadism.

Hypogonadotropic hypogonadism is where there's a deficiency of LH and FSAH, which are the gonadotropins,

...