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Puberty Disorders
➤ Obesity influences pubertal timing, with early puberty more
common in girls with obesity and delayed puberty more frequent
in boys with severe obesity. Precocious puberty is defined as
onset before age eight years in girls and nine years in boys, while
delayed puberty represents the absence of secondary sexual
characteristics by age 13 years in girls and 14 years in boys.
➤ Clinical assessment includes Tanner staging, evaluation of growth
velocity, and determination of bone age. Endocrinology referral is
appropriate for puberty disorders to facilitate proper evaluation
and management. The Tanner stages, or Sexual Maturity Ratings,
classify pubertal development into five sequential stages based
on observable external characteristics:
• Stage 1 represents a prepubertal status with no signs of sexual
maturation.
• Stage 2 marks the onset of pubertal changes (breast budding in
girls, testicular enlargement in boys, and sparse pubic hair in both
sexes).
• Stages 3 and 4 show progressive development of secondary sex
features and growth acceleration.
• Stage 5 denotes full adult maturity with complete genital and
pubic hair development.
