THE YOUNG AND THE PUBERTY

The main alterations that can appear in the puberty refer mainly at the time of their appearance; in effect, it can have a precocious puberty and a delayed puberty, with the consequent anatomical or functional modifications and with different repercussion from the psychic point of view and from the behavior.

The PRECOCIOUS PUBERTY

The appearance of signs of sexual maturity before the physiological age receives the name of precocious puberty.

The age of appearance of the puberty varies remarkably from a population to another one; in our country the inferior limits are accustomed to to be the 9 years for the man and the 8 years for the woman.
Between the different forms from precocious puberty it is necessary to distinguish true the precocious puberty and the precocious pseudopuberty.
True the precocious puberty is characterized by the maturation of the gonads ones (ovaries in the woman and testicles in the man), of the genitals and the secondary sexual characters (hairs, physical aspect, breasts etc.), according to a supposable sequence in its mechanisms and characteristics to the one of the physiological puberty.
True the precocious puberty is secondary to the hypothalamus-pituitary hormonal stimulation and it is associated in the children to menstrual cycles and the men to sperm production.
True the precocious puberty can be triggered more concretely as a result of different causes, that nevertheless almost constantly usually have like common denominator an injury of the central nervous system, and from the hypothalamic region.
Such circumstances occur in the following cases: cerebral tumors, gliomas, craneofaringiomas, astrocitomas, hamartomas; tumors of the epiphysis; and granulomatosas injuries (sarcoidosis, tuberculosis) of the hypothalamic region.

In dysplasia fibrous bony diffuse (syndrome of Albright) true the precocious puberty has its cause in the deformation of the bones of the base of the skull, that due to an effect of local compression stimulates the hypothalamic region. In most of the cases of true precocious puberty, mainly in the woman, it is not possible nevertheless to identify a cause responsible for the sexual maturation.
Neither so at least with the studies modern and specific diagnoses the more (computed axial tomography, stratigraphy) it is possible to show anatomical injuries of encephalon. In these cases, defined as of true and idiopática precocious puberty, alterations of functional order of the nervous mechanisms are evidently in game, that they repress, in pubertal age, the hypothalamus-hipófisis-gónadas activation of the system.

From the practical point of view, the consequences of true the precocious puberty vary remarkably based on that it is about a idiopathic form or a secondary form to a pathological process of the brain.
In this second case the gravity of the disease is closely bound to the nature of the original process (cerebral tumor, granulomatosa injury), to its location and the possibility of surgical extirpation. In the cases of true and idiopathic precocious puberty the sexual maturation lacks in case repercussions on the metabolism and the operation of the genital apparatus.
The consequences fundamentally bear relation to the precocious halting from the growth and the problems of psychological order that must confront the boy in its relation with the other children of its age.
In the precocious pseudopuberty development of the genitals and the secondary sexual characters takes place, without maturation of the gonads ones.
It must to the pathological production of sexual hormones on the part of the suprarenal’s or a tumor of the gonads ones.
The present gonads hormones in the circulatory torrent give rise to the development of the secondary sexual characters, but they block the secretion of the gonadotropinas and inhibit the development of the gonads ones.
Sterility is constant, with absence of menstrual cycles in the woman and production of spermatozoa in the man,
In the precocious pseudopuberty the development of the secondary sexual characters can take place in harmony with genetic sex (isosexual pseudopuberty), or in discordance with this one (heterosexual pseudopuberty), reason why appear signs of malezation in the woman and feminization in the man.
The precocious pseudopuberty is characterized in the man by a precocious increase of the genital organs and by the growth in stature (macrogenitosomíal), in contrast to the presence of small testicles of infantile type.
The secondary sexual characters usually are present, mainly with respect to the development of the hairs.
The precocious pseudopuberty must in the man to an excessive androgen production, either of suprarrenal origin in case of suprarenal tumor or hyperplasia, or of gonadal origin, by testicular tumors.
Secondary cases have also been described neoplasias of nonendocrinos organs, that secrete coriónica gonadotropin (HCG).
In the woman, the precocious pseudopuberty of isosexual type has its origin in producing ovarian estrogen tumors.
The heterosexual precocious pseudopuberty, characterized by abnormal development of clitoris and appearance of secondary sexual characters of masculine type, must to the hypersecretion of androgens on the part of suprarrenales tumors.
Certain enzymatic deficiencies responsible for hiperplasy suprarenal congenital also cause in the woman, in addition to pseudohermafroditismo, heterosexual precocious pseudopuberty.

Forms to incomplete precocious puberty exist in addition when an isolated sexual character is developed precociously.
The most frequent forms are the development of the breasts in the woman and the púbicos hairs. One is anomalies of development nonassociated to alterations of hormonal order, observable in boys of the same age and, in general, without gravity; one thinks that they must to a particular reaction of peripheral weaves front to the action of gonadales hormones.
They can also appear producing signs of precocious sexual maturation in case of neoplasy of gonadotropins. This condition of secondary endocrine dysfunction to one neoplasy is observed of exceptional form in the prepuberal age, since the appearance of neoplasics forms of this type in the adolescence is very rare.
It is possible finally to remember the cases, nothing on the other hand rare, of precocious puberty by drug administration or presence in foods of small amounts of sexual hormones, administered to the cattle with object to accelerate his growth.
Usually one is forms of incomplete precocious puberty.

Tags: adolescent