Puberty can be a stressful and concerning time for adolescents and their families, as it represents a period of significant emotional and physical changes to the body. Puberty normally occurs between the ages of 8 to 13 years for females and 9 to 14 years for males. In females, the first sign of true puberty is breast development or thelarche. In males, the first sign is testicular enlargement, where testicular size increases to a volume of 4 ml or greater, or the length of 2.5 cm. When variation exists on the timing and onset of puberty, the primary pediatrician or provider must closely monitor the child's development and ensure that any pathological or reversible causes are ruled out.
When a child exhibits early signs of puberty, it is defined as precocious puberty. This condition occurs when the first signs of puberty appear before 8 years in females and 9 years in males. However, this activity discusses delayed puberty for females and males. In females, delayed puberty is the lack of breast development by 13 years, a delay of over 4 years between thelarche and completion of puberty, or a lack of menarche by 16 years. In males, a pubertal delay is evident by a lack of testicular enlargement by 14 years or more than 5 years between testicular enlargement and completion of puberty. Puberty represents the maturation of the hypothalamic-pituitary-gonadal (HPG) axis. Development of acne, axillary or pubertal hair, and body odor are a result of adrenal androgen secretion and defined as adrenarche Adrenarche is independent of the HPG axis. Therefore, a child could display signs of adrenarche but still have a diagnosis of pubertal delay.