PUBERTY

Precocious Puberty

ClassificationGnRH dependent (central) : premature reactivation hypothalamus-pituitary-gonad axis increased gonadotropin increased sex steroids (dependent)Usually idiopathicGnRH independent (peripheral): autonomous sex steroid secretion, depressing the hypothalamus-pituitary-gonad axisUsually pathologic

Classification Variantpremature thelarchepremature adrenarchegynecomastia

HypothalamusPituitaryGnRHGonadLH/FSHE2 or T(-)H-P-G axis

HypothalamusPituitaryGnRHGonadLH/FSHSex steroid (-)H-P-G axis in GDPPPrimary

HypothalamusPituitaryGnRHGonadLH/FSH(-)Extra GonadalH-P-G axis in GIPPSex steroid PRIMARY

ConclusionNot all pubertal disorders are pathologicEarly increase of sex steroid should be thoroughly investigatedGnRH agonist = drug of choice for GDPP

LHRHLH/FSHHipotalamusHipofisisTarget Organ(gonad)Sex Steroid Primary defectHipergonadotropik(-)

LHRHLH/FSHHipotalamusHipofisisTarget Organ(gonad)Sex Steroid Primary defectHipogonadotropik(-)DELAYED PUBERTY

KESIMPULANPubertas berlangsung menurut stadium, umur tertentuPubertas harus selalu menjadi perhatian orangtua / tenaga kesehatanSetiap tenaga kesehatan dapat mendeteksi kelainan pubertas secara dini dan segera melakukan rujukan