Puberty in girls is the transition from childhood to adulthood. It is a predictable sequence of events, each judged against population norms, and it ends in reproductive capacity and adult stature.
Its events are named with the suffix -arche, “beginning”: thelarche is the start of breast development, adrenarche the start of adrenal androgen production and menarche the first menstruation. The timing of these events varies with ethnicity and between individuals.
Why can timing go wrong, and how do the notes follow that?
Because each event is judged against a norm, its timing can depart from the normal course in either direction, earlier or later than expected. So puberty is best understood first as it should happen, from growth producing adult height to the ordered appearance of these events, and then through what changes when timing is wrong.
Which note explains what?
- Somatic Growth and Its Determinants in Puberty: the first phase of puberty, the genes that set stature, the hormones that drive the growth spurt and the hormones that close the growth plates, the growing ends of the long bones.
- Normal Physiology of Puberty in Girls: the vocabulary and sequence of thelarche, adrenarche and menarche, their timing, and when the hypothalamic-pituitary-ovarian axis, made of the hypothalamus, the pituitary gland and the ovaries linked by their hormones, becomes mature.
- Abnormal Puberty in Girls: Definitions and Classification: how abnormal timing is defined against the normal range, the age cutoffs that follow from that definition, and the central-versus-peripheral framework used to classify precocious puberty. The classification rests on one question: whether gonadotropins, the pituitary hormones LH and FSH that command the gonads, drive the early puberty.
- Precocious Puberty in Girls: the classification and causes of early puberty, how the diagnosis is confirmed and how the pubertal axis is suppressed.
- Delayed Puberty in Girls: the causes of late puberty, how the underlying failure is identified and how puberty is induced.
The suggested route is to start with somatic growth and then read the notes in the order listed, beginning with the question of what makes a girl grow taller during puberty.