Abstract Ref Number = APCP28
PUBERTY: WHAT ARE THE NEW CHALLENGES?
Adolescence Task Force, Indonesian Pediatrics Society
Pediatric Endocrinology Division, Department of Child Health
Universitas IndonesiaCiptoMangunkusumo General Hospital, Jakarta, Indonesia
Puberty is an important phase in child development. Puberty is defined as the acquisition of secondary sexual characteristics and growth spurt which result in the attainment of reproductive function(1). The normal onset of puberty is between the age of 8.0 to 13.0 years in girls and between 9.0 to 14.0 years of age in boys(2,3). Puberty in girls beginswith breast development followed by pubic hair growth and finally menarche, while in boys puberty typically begins with testicular enlargement followed by pubic hair growth and further virilisation, including voice change and facial hair appearance(4). Growth spurt in girls occurs early inpuberty while in males virilisation precedes growthspurt (4). Genetic, epigenetic, and environmental factors influence the start and progression of puberty(5). Failure to achieve onset of puberty, continuous progression and maintenance adults sex steroid hormones level results in abnormal puberty.
Increased prevalence of obesity has been associated with earlier breast development in girls. Adverse environmental risk factors at early life (children with history of IUGR/SGA) may cause early puberty while environmental factors that occurs at later life (chronic diseases, malnutrition, anorexia, eating disorder) cause delayed puberty or arrested puberty(5,6). The emergence of endocrine disrupting chemicals such as pesticides, BPA, phytoestrogens, and other industrialised chemicals have been noticed to affect the timing of puberty (in animal study to date)(5). Children with chronic diseases such as cancer survivors, chronic kidney disease or thalassemia have higher risks of developing pubertal delay or arrest (5–7). Menstrual disorder (in girls) are not uncommon(5–7).
Puberty is fundamental not only in terms offertility and final height, but also to achieve peak bone mass, reduce the risk of future osteoporosis and future fractures(4). Thus, early detection of pubertal disorders is important.Evaluation of pubertal development should be part of daily practice in managing children especially those with chronic diseases. Comprehensive assessment will result in improved quality of life, reduced risk of osteoporosis and fractures, and possibility of fertility preservation. Careful assessment of pubertal development and appreciation of normal pubertal physiology are the keyto manage children with pubertal disorders(5).
Keywords: puberty, delay puberty, early puberty, chronic disease