Puberty symptoms Assessment Questionnaire

Why: to establish if age of onset of puberty is normal, early or delayed. Precocious puberty indicates that sexual maturation has occurred before the age of 9. Most (90%) cases of precocious puberty are constitutional in origin but ovarian and adrenal hormone secreting tumors must be excluded. Delayed puberty occurs in approximately 2% of the adolescent population and is defined as the absence of any signs of pubertal development by the age of 13 years in girls and 13.5 years in boys or the failure of development progression over a 2 year period.

Why: The events of puberty, that is the time when one becomes able to conceive children, follow a predictable sequence, although the time of onset, velocity of change and age of completion are extremely variable. Changes in the female include the development of pubic hair (which progressively becomes darker, coarser and curlier), the development of breast buds (which progressively become enlarged and elevated), increase in height and the commencement of menstrual periods. Changes in the male include the development of pubic hair (which progressively becomes darker, coarser and curlier), the enlargement and lengthening of the penis, the enlargement of the testicles and the increase in height.

Why: If early, may suggest constitutional precocious puberty which is the most common cause of early puberty. Constitutional delay in puberty is the most common cause of delay in puberty and accounts for 90% of cases.

Why: i.e. to increase their body mass - may be associated with precocious puberty due to estrogen or androgen effects.

Why: Any chronic illness or poor nutrition in children can cause delayed puberty such as cystic fibrosis, thallasaemia and juvenile chronic arthritis. Hormonal causes of delayed puberty include hypopituitarism , Kallmann syndrome, hypothyroidism and hyperprolactinemia. Causes of precocious puberty include brain tumors, hydrocephalus, encephalitis, meningitis, McCune-Albright syndrome, craniopharyngioma, tuberous sclerosis, hepatoblastoma, choriocarcinoma and hypothyroidism.

Why: e.g. corticosteroids may cause a Cushing's syndrome which may be associated with early puberty.

Why: e.g. parental precocious puberty, parental delay of puberty.

Why: e.g. puberty starting before age 9 in boys such as enlargement of the scrotum, testicles and penis; pubic hair growth and deepening of voice.

Why: e.g. breast budding occurring before age 8 or first menstrual period before age 9.

Why: e.g. deepening of voice, acne, loss of menstrual periods, hairiness, enlargement of clitoris, breasts shrink, muscle mass increases - may suggest arrhenoblastoma (a rare ovarian tumor).

Why: Acne is virtually universal in adolescence. Prevalence peaks between the ages of 14-16 years in females, and 16-19 years in males.

Why: The experience of a changing body in puberty often causes the adolescent to feel out of control. Feelings of persecution and helplessness are common and may not cease until about one year after the growth spurt has ended. The typical aggressiveness, sexual arousal and unpredictability of the early adolescent are largely due to hormonal changes. Adolescents have a heightened awareness of bodily change; they are normally narcissistic and thus are preoccupied with issues of adequacy. Young adolescents are often concerned that their growth and development are not progressing normally. For boys, in particular, the psychological effects of being slow to develop, too short or too thin in comparison with one's peers can be profound, while excessive tallness may provide particular difficulties for girls.

Why: may suggest a brain tumor e.g. pinealoma which may be associated with early puberty.

Why: e.g. weight gain especially central abdominal, change of appearance, moon-like face, thin skin, easy bruising, excessive facial hair growth, acne, muscle weakness, lack of or rare menstrual periods, poor libido, depression, psychosis, insomnia, frequent urination, excessive thirst, growth arrest and early puberty in children.

Why: e.g. isolated dark-brown to light brown patches which tend to remain on one side of the midline especially on the back, buttocks or scalp. May also be associated with early puberty.