17 7- What are the shortcomings of genital staging proposed by Tanner?
The genital staging proposed by Tanner and Marshall considers the develop-
ment of testis, penis, and scrotum together in a comprehensive manner.
Although the development of testis and penis can be assessed objectively, the
assessment of scrotal development (rugosity, darkening) is subjective. During
normal puberty, the development of testis, penis, and scrotum occurs simulta-
neously, and staging of genitalia can be ascertained easily. However, in patients
with GIPP, there is dissociation between testicular and penile development, and
assignment to a particular genital staging is difficult.- What is “accelerated” puberty?
Girls and boys who have onset of pubertal events at a normal age, but experi-
ence rapid progression of pubertal development (whether sequential or not), are
said to have “accelerated” puberty. This may be due to CNS lesions and adre-
nal, ovarian, or testicular tumors, which have evolved after the onset of puberty.
Although by definition these children do not have precocious puberty, rapid
progression of pubertal events merits evaluation in these children.- How is precocious puberty classified?
Precocious puberty is classified based on presence or absence of premature
reactivation of hypothalamo–pituitary–gonadal (HPG) axis.Classification based on HPG-axis
Gonadotropin-dependent precocious puberty (GDPP)/true or complete precocious puberty
Precocious puberty due to premature reactivation of HPG-axis
Development of secondary sexual characteristics is sequential and progressive
Thelarche followed by pubarche and menarche in girls and gonadarche followed by
pubarche in boys
Gonadotropin-independent precocious puberty (GIPP)/pseudo or incomplete
precocious puberty
Precocious puberty due to excess of sex steroids independent of reactivation of HPG-axis
Endogenous/exogenous sex steroids
Extrapituitary secretion of gonadotropins (hCG)
Development of secondary sexual characteristics is nonsequential and may or may not be
progressive
Menarche at Tanner breast stage 2 or disproportionate penile enlargement in relation to testes
Normal variants of puberty
Isolated premature thelarche
Isolated premature pubarche
Isolated premature menarche- What is isosexual precocious puberty?
Isosexual precocious puberty is defined as premature development of secondary
sexual characteristics in concordance with chromosomal and gonadal sex,6 Precocious Puberty