GynaecologyFree in the app
Puberty problems
Too early, too late, and Tanner staging.
Source: Standard teaching| Precocious puberty | Signs before 8 years. Central: mostly idiopathic in girls. Peripheral: ovarian cyst or tumour, McCune-Albright, CAH. |
|---|---|
| Work-up | Bone age, LH/FSH (GnRH test), pelvic scan, brain MRI. Central: GnRH agonist. |
| Delayed puberty | No breasts by 13, or no periods by 15 (or 3 years after breasts). |
| Low FSH/LH | Constitutional delay, low BMI, Kallmann, pituitary disease. |
| High FSH/LH | Turner syndrome, premature ovarian insufficiency. |
Tanner breast stages
| B1 | Prepubertal. |
|---|---|
| B2 | Breast bud (thelarche, 8–13 years). |
| B3 | Breast and areola enlarge together. |
| B4 | Areola forms a secondary mound. |
| B5 | Adult contour. |
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.