Physiology of puberty.

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.