View Entire Collection
By Clinical Topic
By State Requirement
Faith Community Nursing
Future of Nursing Initiative
PUBERTY in girls occurs at an earlier age in the 21st century than it did 100 years ago, particularly in African American (AA) girls. By understanding the biological basis of puberty through laboratory studies and epidemiologic analyses, we may be able to begin to address this issue in the underserved population of AA adolescent girls.
Pubertal development in humans is manifested by changes in secondary sex characteristics in the body, including genital and breast development, the first appearance of axillary hair, and changes in body shape and composition. However, it is becoming increasingly clear that the pubertal process in mammals is stimulated by gonadotropin-releasing hormone (GnRH), produced in about 1,000 cells in the hypothalamus.1 GnRH is released from hypothalamic neurons in pulses of approximately hourly intervals, into a small capillary system that leads to the anterior pituitary. At the pituitary, GnRH regulates the release of 2 additional hormones released to control the synthesis and release of gonadal steroid hormones (estrogens, progestins, and androgens) and gametogenesis (sperm production in males, ovum production in females). While all 3 levels of this hypothalamic-pituitary-gonadal (HPG) axis must function for puberty to progress, the activation of neural GnRH cells is the primary driver.1
Prior to the activation of the HPG axis in infancy and childhood, GnRH secretion is minimal.2 At the onset of puberty in both males and females, pulsatile GnRH release increases significantly. Although it is not possible to measure GnRH release directly in humans, animal models have demonstrated how GnRH pulses change during puberty. Studies with rhesus monkey models show that prior to puberty, GnRH pulses are extremely small, occur at very low frequency, and increase in frequency and amplitude during subsequent pubertal development.3 These changes drive pubertal changes in pituitary and gonadal hormones.
Significant sex differences have been documented in the timing of puberty in humans. Puberty in American girls is associated with breast development, which occurs at an average age of 10.5 years, and menarche (first menses), occurring at 12.8 years when averaged for all races.2 Puberty in boys, which occurs slightly later, is associated with increased testicular size.2 Such sex difference also exists in rodent models.4 In our laboratory, we find that the timing of puberty differs in males and females, with the achievement of adult reproductive function occurring later in male rodents, as in humans.1
Disorders and effects of disruptions of puberty are also sexually dimorphic. Delayed puberty (the lack of development considered normal for pubertal age) is more prevalent in males than in females; precocious or early puberty5 is more common in females. The demographics of puberty have also shifted over the past century. The timing of puberty in girls has undergone a dramatic advance, while it has not changed very much for boys during this time.6 Hygienic and environmental improvements are thought to contribute, though it does not explain why male puberty seems unaffected.6 Nutritional standards have also improved, with increased obesity among children, which may also contribute to earlier puberty in girls, as fatty tissues accumulate estrogens, which are important for sex development.6,7 Boys who are overweight show delayed development when compared to boys of average weight.8 Other environmental factors also need to be considered to elucidate this sex difference in the timing of puberty.
Rodent models provide insights into mechanisms for the sex differences for puberty. Treatment of prepubertal rats with a drug to block the effects of GnRH on its pituitary gland target cells caused delayed puberty in male but not female rats.9 Surprisingly, effects of this drug on male reproduction were observed weeks after treatment had ceased. The effect was reversible but took up to a month for males to regain reproductive capacity. Rodent results are consistent with human findings for a higher prevalence of delayed puberty in males, and experimental studies from our laboratory and others allow us to better understand these processes in humans.
The overall trend for earlier puberty in the last century is especially prevalent in AA girls, with Mexican Americans having puberty at an intermediate age.10 On average, AA girls go through puberty 1-1.5 years earlier than White girls (~age 9 years for AAs, ~10-10.5 years for Whites for breast development and the first appearance of pubic hair).10 Menarche, the first menstrual period, occurred at age 12.16 in AA and 12.88 in White girls.10 The reason for these racial differences is not well understood, but ethnic differences in food consumption and usage of products that contain estrogens are both possible factors. Several studies have noted that AA girls are larger in size prepubertally, which is thought to contribute to earlier development.11 The standards for precocious puberty have had to change to reflect these demographic trends. In females, puberty is now said to be precocious if it occurs before the age of 7 in White girls and the age of 6 in AA girls.5 Although precocious puberty may be considered benign, it may result in psychological or social problems and earlier sexual activity.5 Regardless of species, sex, or race, the precipitating factor for puberty is a change in the brain's release of the GnRH. This is a consideration for interventions for extremely early or late puberty, as pharmaceutical agents that stimulate or delay inappropriately late or early puberty are already in use.
1. Gore AC. Modulation of the GnRH gene and onset of puberty. In: Bourguignon JP, Plant TM, eds. Control of the Onset of Puberty. Amsterdam: Elsevier; 2000:25-35. [Context Link]
2. Pinyerd B, Zipf WB. Puberty-timing is everything!! Journal of Pediatric Nursing. 2005;20:75-82. [Context Link]
3. Terasawa E. Luteinizing hormone-releasing hormone (LHRH) neurons: mechanism of pulsatile LHRH release. Vitamin Hormones. 2001;63:91-129. [Context Link]
4. Gore AC, Roberts JL, Gibson MJ. Mechanisms for the regulation of gonadotropin-releasing hormone gene expression in the developing mouse. Endocrinology. 1999;140:2280-2287. [Context Link]
5. Kaplowitz PB. Precocious puberty: update on secular trends, definitions, diagnosis, and treatment. Advances in Pediatrics. 2004;51:37-62. [Context Link]
6. Papadimitriou A. Sex differences in the secular changes in pubertal maturation. Pediatrics. 2001;108:E65. [Context Link]
7. Rogol AD, Roemmich JN, Clark PA. Growth at puberty. Journal of Adolescent Health. 2002;31:192-200. [Context Link]
8. Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics. 2002;110:903-910. [Context Link]
9. Hughes SM, Yin W, Gore AC. The GnRH antagonist acyline delays puberty and suppresses the reproductive axis of male but not female rats. In: Program and abstracts of the Endocrine Society; 2006; Boston, MA. [Context Link]
10. Herman-Giddens ME. Recent data on pubertal milestones in United States children: the secular trend toward earlier development. International Journal of Andrology. 2006;29:241-246. [Context Link]
11. Herman-Giddens ME, Slora EJ, Wasserman RC, et al. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings Network. Pediatrics. 1997;99:505-512. [Context Link]
For life-long learning and continuing professional development, come to Lippincott's NursingCenter.
Caring for...Patients of different religions
Nursing Made Incredibly Easy!, November/December 2014
Expires: 12/31/2016 CE:2 $21.95
Autoimmune disease: Cost-effective care
Nursing Management, November 2014
Expires: 11/30/2016 CE:1.5 $17.95
CE: Original Research: Staff Nurses' Perceptions Regarding Palliative Care for Hospitalized Older Adults
AJN, American Journal of Nursing, November 2014
Expires: 11/30/2016 CE:2.5 $24.95
More CE Articles
Subscribe to Recommended CE
Dogs as Pets, Visitors, Therapists and Assistants
Home Healthcare Nurse, November/December 2014
Free access will expire on January 5, 2015.
Nursing2014 Critical Care, November 2014
Free access will expire on December 22, 2014.
Effective management of ARDS
The Nurse Practitioner, 13December 2014
Free access will expire on December 22, 2014.
More Recommended Articles
Subscribe to Recommended Articles
Back to Top