Christine Krause,M.D.
Learning Objectives:
- Review the process of normal sexual maturation
- Review tanner staging
- To be able to counsel patients and parents about “range
of normal” during puberty and recognize clinical situations which may
be abnormal
- To be able to begin an investigation for cases of precocious
puberty while waiting for subspecialty support
Primary references:
1. Biro F. Up to Date on “Normal Puberty” last updated in Sept. 2007 at
www.utdol.com.
2 .Brodsky J. and Carpenter T. Puberty Cases on the
Yale Primary Care Curriculum at http://course information.med.yale.edu.
3. Muir A. Pediatrics in Review “Precocious
Puberty”. 2006; 27:373-8
4. Rosen DS. Pediatrics in Review “Physiologic
growth and development during adolescence” . 2004: 25(6): 194-9.
5. Saenger P. Up to Date on “Overview of Precocious
Puberty” last updated on Sept 2006 at www.utdol.com.
Tanner Staging and Puberty Cases
Case One:An 9 year 3 month old African American girl comes
to you in clinic for a well child check up. You discover that she has tanner
2 breast buds and pubic hair.
Her mother menstruated at age 11 years.
How do you counsel this patient about her pubertal findings?
Case 2: An 13 year old boy walks into clinic with
“a lump on his breast”. He is extremely worried that something is wrong
with him. Palpable breast buds are noted during the exam along with some
axillary hair. He is slighly overweight. How do you counsel this patient?
Case 3: A 10 year old girl who is 5 ft. 4 inches comes in
to your clinic for a routine check up and is found to have tanner 3 breasts
and tanner 2 pubic hair. She wants to know when her period will start and
wonders how much taller she will become?
She has grown 3 and ½ inches in the past year.
Precocious Puberty
Case1:A 6 year old African American girl presents for a
well child exam and during the exam you discover tanner 2 to 3 pubic hair.
She has no breast buds or axillary hair and her growth curve has remained
steady at the 50% for height and weight. Upon questioning the mother, she
says the pubic hair has been there for several months and wonders if she
should be worried that these changed are happening too soon.
Case 2: The mother of a 7 yr old hispanic boy mentions to
you as you are leaving the room after an asthma exacerbation recheck that
there is something wrong “down there”. When you put the patient back on
the exam table, you discover tanner 3 pubic hair that was not present on
last summer’s well child visit.
