Pubertal development between 8 and 18 years is reported in 142 Swiss males of the First Zurich Longitudinal Study (1954-1980). Genital and pubic hair development were rated according to TANNER [14]. Testicular growth was assessed by comparative palpation with the orchiometer of PRADER [10]. The age at which pubertal development was initiated varied between the eighth and the fifteenth year of life. Reaching a testicular volume of 3 ml was found to be the most reliable indicator for the onset of pubertal development. The various pubertal stages of genital and pubic hair development tended to occur at earlier ages in this study than previously reported. This was particularly true for PH6 which was observed in 73% of the boys by age 20. Standard deviations of 1.0 to 1.5 years for the ages at which the pubertal stages were reached reflected the large variations in the timing of pubertal development. The mean duration of genital development was 3.5 +/- 1.1 years, of pubertal penis growth 1.8 +/- 0.7 years, of pubertal testicular growth 3.5 +/- 1.0 years and of pubic hair development 2.7 +/- 1.0 years. Moderate correlations were found between the ages at which genital development, pubic hair development and pubertal testicular growth were initiated. The ages at completion of these pubertal characters and the age at which the peak of the adolescent growth spurt was reached were highly positively correlated with each other. For a given stage of a pubertal character at least 80% of the children were within two successive stages of any other pubertal character, e.g. 87% of the boys were either in G2 or G3 when they reached PH2. No significant relationship between the durations of genital development, pubic hair development and pubertal testicular growth could be established. Likewise no significant relationship could be found between the timing and duration of pubertal development.

Pubertal development in Swiss boys

The prevalence of obesity continues to rise in adult and pediatric populations throughout the world. Obesity has a direct impact on all organ systems, including the reproductive system. This review summarizes current knowledge about the effects of obesity on the male reproductive system across age, highlighting the need for more data in children and adolescents. Male hypogonadism is commonly seen in patients with obesity and affects the onset, duration, and progression of puberty. Different pathophysiologic mechanisms include increased peripheral conversion of testosterone to estrone and increased inflammation due to increased fat, both of which lead to suppression of the hypothalamic-pituitary-gonadotropin (HPG) axis and delayed development of secondary sexual characteristics in adolescent males. Evaluation of the HPG axis in obesity includes a thorough history to exclude other causes of hypogonadism and syndromic associations. Evaluation should also include investigating the complications of low testosterone, including increased visceral fat, decreased bone density, cardiovascular disease risk, and impaired mood and cognition, among others. The mainstay of treatment is weight reduction, but medications such as testosterone and clomiphene citrate used in adults, remain scarcely used in adolescents. Male hypogonadism associated with obesity is common and providers who care for adolescents and young adults with obesity should be aware of its impact and management.

Obesity and Hypogonadism-A Narrative Review Highlighting the Need for High-Quality Data in Adolescents.

Department of Biometry and Medical Documentation, University of Ulm, Ulm, GermanyObjective: To investigate clinical and laboratory markers of pubertal development in a large sample of obese children andadolescents.Methods: Analysis of parameters of sexual maturation in 1232 obese individuals (582 boys) aged 6–18 years (mean 13.072.42years). Clinical evaluation of pubertal stage and determination of bone age in a subset (227 patients).Results: Mean Height – standard deviation scores (height–SDS) was positive during childhood and reached zero approximatelyat age 14 years followed by a turn to negative mean height–SDS in both genders. Accordingly, bone age was accelerated untilage 14. No significant differences in average time points of occurrence of pubic hair stages PH 2 to PH 4 in boys and PH 2 to PH5 in girls were observed as compared to references of the First Zurich Longitudinal Study. In girls, breast stage B 3 was reachedearlier (11.6 vs 12.2 years, P¼0.03). In boys, mean volume of testis revealed no significant deviation from reference. Meandehydroepiandrosterone sulfate (DHEAS) levels were elevated in boys (within age ranges 8–10 years and 12–16 years, Po0.02)and in girls (within age ranges 6–8 years and 12–18 years, Po0.005) and mean testosterone levels in boys 412 years were loweras compared to reference ranges (all P-values o0.0001).Conclusion: The study data suggest normal development of pubarche and gonadarche in obese German boys and normaltiming of pubarche in girls. Breast development in obese girls seems to be slightly advanced. In obese boys, an obviousdissociation of clinical and laboratory parameters of pubertal development was observed. Despite significantly increased height–SDS and increased DHEAS levels, gonadal development was normal and testosterone levels were decreased. Elevated DHEASlevels in both genders may contribute to the acceleration of bone maturation, a lower final body height and could increasecardiovascular risk.International Journal of Obesity (2007) 31, 1509–1519; doi:10.1038/sj.ijo.0803691; published online 24 July 2007Keywords: childhood obesity; pubertal development; pubarche; gonadarche; bone age; growth

PEDIATRIC HIGHLIGHT Pubertal development in obese children and adolescents

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PEDIATRIC HIGHLIGHT Pubertal development in obese children and adolescents