Normal Pubertal Development: Part II: Clinical Aspects of Puberty

Brian Bordini; Robert L Rosenfield

doi:10.1542/pir.32-7-281

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Brian Bordini, MD*
Robert L Rosenfield, MD*

^*Section of Adult and Pediatric Endocrinology, The University of Chicago Pritzker School of Medicine, Chicago, IL.

Author Disclosure
Drs Bordini and Rosenfield have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Objectives

After completing this article, readers should be able to:

Describe the usual sequence of pubertal development in boys and girls.
Describe how linear growth during puberty is related to pubertal stage.
Identify pubertal abnormalities that require further evaluation.

Part I of this article, which deals with the endocrine basis of puberty, was published in the June 2011 issue of Pediatrics in Review.

Stages of Puberty and Their Evaluation

Sexual Maturity Rating (SMR) staging of sexual development, also known as Tanner staging, provides a means of discretely documenting a child's progression through puberty by inspection. Separate scales are used for breast (female), genital (male), and pubic hair (both sexes) development (Figs. 1 and 2). (1)(2)(3) By definition, SMR stage 1 is prepubertal. Pubertal development of the gonads is indicated specifically by thelarche (breast stage 2) in girls (Fig. 1) and testicular enlargement (genital stage 2) in boys (Fig. 2). Pubertal development is ongoing at stage 3, nearly complete by stage 4, and complete and adultlike at stage 5.

Figure 1.

Stages of breast and pubic hair development. Stage 1 is prepubertal. Breast stages (left panel): 2–a subareolar breast bud, 3–elevation of the breast contour and enlargement of the areolae, 4–the areolae form a secondary mound above the contour of the breast, 5–mature female breast with recession of the secondary mound and a dependent breast contour. Pubic hair stages (right panel): 2–sparse, fine, straight pubic hair; 3—long, dark, curly hair; 4–pubic hair resembles adult pubic hair in quality but not distribution, having not yet spread to the thighs; 5–pubic hair has adult quality and distribution, with spread to the medial thighs. Males go through the same …