ISSN:1663-2818    

DOI:10.1159/000183947

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:1663-2818    

DOI:10.1159/000183948

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Puberty is not a single event but one stage in development. The endocrine events of puberty in many ways recapitulate previous changes in the fetus. It is currently not known what triggers puberty at an appropriate time. It appears that puberty is restrained by higher central nervous system controls, but the restraint can be eliminated by injury or tumor growth resulting in premature puberty. The first endocrine event of puberty is an increase in the amplitude of gonadotropin pulses at night due to increased pulsatile release of hypothalamic gonadotropin-releasing hormone (GnRH) into the hypothalamic-pituitary portal system. This is reflected by an increase in luteinizing hormone secretion after a bolus of exogenous GnRH. Gonadal steroids are produced due to increased gonadotropin stimulation, and secondary sexual development follows a well-described pattern of changes. The pubertal growth spurt results from an increase in growth hormone secretion induced by sex steroids as well as from local production of growth factors. Positive feedback leads to the onset of menses and ovulation in girls by mid-puberty or later. This physical and reproductive maturity occurs in an orderly pattern, of which the physiology is described and in large part understood.

ISSN:1663-2818    

DOI:10.1159/000183949

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Premature pubarche, premature thelarche and complete precocious puberty are usually simply normal phenomena occurring at an early age. This is not necessarily the case, however, and they may sometimes be harbingers of reproductive endocrine disturbances in adulthood. Consequently, girls with these complaints cannot be entirely reassured that they are of no consequence, and they should be followed to ascertain whether pubertal reproductive function is eventually normal.

ISSN:1663-2818    

DOI:10.1159/000183950

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Central precocious puberty is characterized by premature activation of the hypothalamic gonadotrophin-releasing hormone (GnRH) pulse generator, resulting in accelerated growth and bone maturation with clinical signs of gonadarche before the age of 8 years in girls and 9 years in boys. In rapidly progressing central precocious puberty, the plasma luteinizing hormone (LH) response to exogenous GnRH exceeds the reference range for sex and stage of puberty, and the ratio of LH:follicle-stimulating hormone after GnRH is usually above 1 [1]. Short adult stature, with unfavourable body proportions, i.e. an increased upper:lower segment ratio, is probably the only handicap of idiopathic central precocious puberty that persists into adulthood. This cannot be avoided by treatment with either medroxyprogesterone or cyproterone acetate. Following the first report of pituitary-gonadal suppression in a 2-year-old girl with central precocious puberty using daily injections of the gonadotrophin-releasing hormone (GnRH) agonist deslorelin [2], various short-acting GnRH agonists have been studied in children with central precocious puberty. Some of the older patients treated for shorter periods have now reached adult or near-final height. By 1985, slow-release (depot) GnRH agonists, such as triptorelin and later leuprorelin, were available. These are injected only once every 4 weeks instead of daily or given by nasal spray six times daily, making long-term treatment much more acceptable to patients and their parents. Moreover, suppression of gonadarche is more complete with long-acting (e.g. triptorelin) compared with short-acting (e.g. buserelin) agonists, resulting in significantly slower bone age progression and, thus, greater improvement in predicted, and probably also in achieved, final height [3]. A multicentre trial of depot triptorelin organized by the German/Dutch Central Precocious Puberty Study Group enrolled 104 children. Pubertal development was arrested or regressed, behaviour improved markedly and menstruation ceased in all the girls receiving the drug. Pathological increase of height velocity and bone maturation normalized, and the predicted adult height increased significantly by a mean of 1.5 cm/treatment year. After cessation of depot triptorelin treatment, the mean height prediction decreased slightly and the approximate adult height remained comparable with the predicted height at the start of treatment (in most cases slightly below genetic target height), due to a reacceleration of bone maturation. This is similar to the results obtained with short-acting GnRH agonists. After treatment, normal puberty and, in girls, cyclic ovarian function, returned progressively. No side-effects or antibodies were observed [4]. Depot GnRH agonists appear to be the treatment of choice for long-term therapy of central precocious puberty. Not only is long-term compliance good, but also, because of their superior suppressive effects on bone maturation, the previously severely compromised adult height of such patients can be avoided. Whether additional treatment with growth hormone will improve final height in a subgroup of patients with a pathologically low final height prediction and/ or target height remains to be studied in a sufficiently large number of children on a long-term basis.

ISSN:1663-2818    

DOI:10.1159/000183952

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:1663-2818    

DOI:10.1159/000183953

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:1663-2818    

DOI:10.1159/000183954

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Puberty and adolescence are not generally times of great stress and turmoil. The storm-and-stress theory has a long history, but can no longer be supported by recent empirical research. A modern approach to the psychosocial changes of these phases is based on the concept of developmental tasks in an age-appropriate and stage-appropriate way. Biological processes can influence an individual’s psychological and psychosocial state, but psychological and psychosocial events may also influence the biological systems. Therefore, the timing and outcome of pubertal processes can be modified by psychosocial factors. The most important psychological and psychosocial changes in puberty and early adolescence are the emergence of abstract thinking, the growing ability of absorbing the perspectives or viewpoints of others, an increased ability of introspection, the development of personal and sexual identity, the establishment of a system of values, increasing autonomy from family and more personal independence, greater importance of peer relationships of sometimes subcultural quality, and the emergence of skills and coping strategies to overcome problems and crises. All these changes can be looked on as developmental tasks during normal development, but they can also help in understanding developmental deviations and psychopathological disorders. From the viewpoint of developmental psychopathology, several psychiatric disorders of puberty and adolescence can be seen in a new ligh

ISSN:1663-2818    

DOI:10.1159/000183955

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

This paper will deal with the psychologic correlates of abnormal puberty and the implications for assessment and treatment. The main areas of adolescent behavior, equally relevant to the child who undergoes normal or abnormal puberty, are psychosexual development, psychopathology and mental functioning in terms of level of intelligence and cognitive strengths and weaknesses. Regarding psychosexual development, the important findings are that adolescents with precocious puberty tend to be somewhat earlier in starting their adolescent sex life, though they still remain within the normal range of current standards. The reports on psychopathology in children with precocious puberty on a short-term or long-term basis are based on clinical case reports and systematic studies and suggest that a history of precocious puberty may carry with it an increased risk of psychopathology. IQ and school achievement are typically not negatively affected in precocious puberty; in fact, there is a suggestion of the opposite. It may be that there is an advantage in intellectual development associated with early pubertal maturation, which may be temporary rather than long-term.

ISSN:1663-2818    

DOI:10.1159/000183956

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A model of determinants of psychosocial adaptation in chronic disease includes general and specific disease characteristics, life events and stress, personality, family and social environment. This model is used as a guide for the analysis of the individual process of psychosocial adaptation in order to assist the patient. Furthermore, based on findings of empirical studies, the increased risk of psychiatric disorders reflecting maladaptive coping processes is outlined. Finally, some fundamental considerations regarding psychological rehabilitation within paediatric care are presented.

ISSN:1663-2818    

DOI:10.1159/000183957

出版商:S. Karger AG    

年代:1994

数据来源: Karger