Changes in the gonadal and adrenal steroid patterns during puberty

Longitudinal study of hormonal and physical development in young twins

CONTEXT AND OBJECTIVE

Information on the correlation of normative reproductive hormone levels with physical development (Tanner stages) during puberty and on the influences of genes and environment on variation in these hormones and Tanner stages is limited.

DESIGN, SETTING, AND PARTICIPANTS

One hundred twelve healthy 9-year-old twin pairs (n = 224) took part in a longitudinal study, of which 89 pairs participated again at age 12 years (n = 178).

MAIN OUTCOME MEASURES

Morning urinary LH, FSH, estradiol, and salivary testosterone levels, determined by competitive immunoassays, were measured. Tanner stages were determined through physical examination.

RESULTS

Over the 3-year interval, all hormone levels showed a 2- to 9-fold increase. LH and FSH at age 9 years predicted sex-specific Tanner stages at age 12 years in both boys and girls. Most of the associations between hormone levels at age 9 years and physical development at 12 years were explained by genetic influences. FSH in 9-year-old boys correlated with all hormone levels and Tanner stages at age 12 years. Moderate to high heritability estimates were found for hormone levels at both ages and in both sexes. In girls a shift from environmental (age 9 years) to genetic influences (age 12 years) was found for estradiol and pubic hair development, and for breast development a shift in the opposite direction was seen.

CONCLUSIONS

During development LH and FSH (and testosterone in boys) levels predict secondary sexual characteristics in boys and girls 3 years later. These correlations are largely due to genes that are involved in both early pubertal hormone levels and subsequent physical development.

The early dehydroepiandrosterone sulfate rise of adrenarche and the delay of pubarche indicate primary ovarian failure in Turner syndrome

Pubarche without thelarche has been taken as clinical evidence that adrenarche is independent of gonadarche in females. This study examines whether the course of adrenarche [rise of serum dehydroepiandrosterone sulfate (DHEAS)] and pubarche (Tanner stage PH2) is independent from ovarian function. Serum DHEAS levels (n = 867) were longitudinally measured in 111 girls with Turner syndrome between 1990 and 2002. Of these, 22 had spontaneous puberty onset (Tanner stage B2), and 45 had primary ovarian failure (POF). Serum DHEAS levels were assayed by chemiluminescence and compared with those of healthy girls (n = 322; age range, 3-17 yr in both groups). Between the ages of 7 and 17 yr, girls with Turner syndrome had significantly higher age-related DHEAS levels than normal girls (P </= 0.02). Moreover, in the 9- to 15-yr-old girls, DHEAS levels were significantly higher in girls with Turner syndrome and POF than in Turner syndrome girls with spontaneous puberty onset (P </= 0.02). This discrepancy was caused by an earlier adrenarche (DHEAS levels reaching 1.1 micro mol/liter) in Turner syndrome girls with POF, which occurred at a median age of 8.3 yr (80% confidence interval, 6.5-10.4 yr) vs. 10.5 yr (8.6-12.2) and 11.0 yr (8.9-12.6) in Turner syndrome girls with spontaneous puberty onset and normal girls, respectively (P = 0.003). In contrast, pubarche was delayed in Turner syndrome girls with POF [median age, 13.0 yr (80% confidence interval, 10.6-15.0) vs. 11.9 yr (10.5-13.2) in Turner syndrome girls with spontaneous puberty onset (P = 0.02) and 11.6 yr (10.6-12.5) in normal girls]. Primary gonadal failure in Turner syndrome is associated with an earlier onset of adrenarche, but delayed pubarche. These data demonstrate that normal timing of adrenarche is dependent on gonadal function and suggest that normal pubarche is the clinical manifestation of the ovarian conversion of DHEAS to active androgens.

Evolving self-image, pubertal manifestations, and pubertal hormones: preliminary findings in young adolescent girls

PURPOSE

Recent studies indicate that negative self-image increases in white females during early adolescence. This study was designed to examine the effects of physical and hormonal change during puberty on evolving self-image.

METHODS

The study sample consisted of 54 girls aged 10-14 yrs (mean 12.2 +/- 0.9). Evaluations at baseline and one-year follow-up included the Self-Image Questionnaire for Young Adolescents (SIQYA), physical examination, and assays of serum FSH, LH, estradiol, testosterone, and DHEAS. Tanner stage was assessed separately for breast and pubic hair, and the girls were classified as early-, mid-, or late-maturers for each.

RESULTS

Pearson correlations between baseline and follow-up scores on the nine SIQYA scales ranged from 0.28-0.72 (P < 0.05); three scales demonstrated declining function (P < 0.05). At baseline, 39 girls (72%) were pre-menarcheal compared to 27 (50%) at follow-up. Mean body mass index (BMI) increased from 18.62 +/- 2.38 to 19.01 +/- 1.84 (P < 0.001), Tanner stages each increased by one, and pubertal timing did not change. LH and testosterone increased (P < 0.05) over the year, DHEAS decreased (P < 0.01), and FSH and estradiol did not change. Stepwise linear regression revealed that change in breast stage was positively correlated with change in Body Image score and change in Adjustment score (beta weights 0.46 and 0.41, respectively). Change in testosterone was negatively correlated with change in Adjustment score (beta weight of -0.46). After controlling for baseline score, change in breast stage was positively correlated and FSH was negatively correlated with follow-up Body Image score (beta weights of 0.40 and -0.24, respectively).

CONCLUSION

We conclude that the rate of breast development and FSH level have independent, opposite effects on body image during early adolescence.

Some seasonal changes in the thecal gland in the ovaries of hibernators (Citellus citellus L.)

The ovaries of 36 ground squirrels were studied in March, April, July, and December. Morphological and functional seasonal characteristics of theca interna were studied by histological methods, electron microscopy, and quantitative methods for determinating the volume density and histoenzyme activity of NADH2-tetrazolium reductase, glucose-6-phosphate dehydrogenase, and delta 5-3 beta-hydroxysteroid dehydrogenase. Maximal activity of theca interna as a steroid-producing structure was observed during spring awakening. A significant increase in the histoenzyme activity of delta 5-3 beta-hydroxysteroid dehydrogenase in December, versus two other enzymes studied, indicated steroid synthesis in theca terna.

Gingival health and gingivitis development during puberty. A 4-year longitudinal study

The purpose of this investigation was to follow the development of the gingival conditions during puberty and to correlate oral clinical parameters with chronological age as well as with parameters used for the determination of the pubertal development. In 22 boys and 20 girls pubertal and skeletal development, as well as plaque index (PlI) and gingival index (GI) were monitored at 1-year intervals between the ages of 11 and 15 years. During this time, the papillary bleeding index (PBI) was assessed 10 times in all interdental spaces of the dentition. The bleeding tendency, represented by whole mouth mean PBI values, as well as the % of bleeding interdental sites, was found to increase significantly with the start of the pubertal phase. It reached a peak value after 1-5 years in 35% of the children. A significant trend of decrease was noted after the age of 14 years in boys and girls. In boys, mean PBI and the % of interdental sites with bleeding were correlated with testes growth, in girls with the Tanner index for secondary sex characteristics (breast development). PlI and GI, which were only recorded annually, did not show a significant trend of increase or decrease.

Seasonal changes of the ovarian atretic follicles of the ground squirrel (Citellus citellus L.)

The ovaries of 84 ground squirrels (C. Citellus L.) were studied during the four seasons of the year. The ovarian atretic follicles were examined by histological methods and by electron microscopy. The histoenzyme activities of NAD.H2-tetrazolium reductase, glucose-6-phosphate dehydrogenase, and 3 beta-hydroxy-delta 5-steroid dehydrogenase were photometrically demonstrated. The steroid-producing atretic follicles were mainly described as they reached their highest enzyme activity during the lactation period in April. The atresia of the primordial and primary follicles was manifested by disappearance of the oocyte and preservation of the granulose cells surrounded by basal lamina. Atresia of follicles with two oocytes was a typical process for the ground squirrel. Later on the oocytes and the granulose cells around it disappeared. The remaining part of the follicle continued its development and reached maturity. Atresia was observed mainly in March, April, and May.

Developmental processes in early adolescence. Relations among chronologic age, pubertal stage, height, weight, and serum levels of gonadotropins, sex steroids, and adrenal androgens

Cross-sectional data are presented on 108 young adolescents (56 boys, 52 girls), ages 9 to 14 years. The measures were: for all subjects, pubertal stage (Tanner criteria for genital/breast and pubic hair stage); height and weight; serum hormone concentrations for gonadotropins (luteinizing hormone and follicle-stimulating hormone), sex steroids (testosterone, estradiol, and the computed testosterone to estradiol ratio), adrenal androgens (dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione), and testosterone-estradiol binding globulin. In addition, testicular volume for boys and menarchial status for girls are reported. The study goal was to provide interrelations among these measures, based on the same sample, and examine their interchangeability. Results suggest that it would be reasonable to compare research across as well as within studies based on different markers. Multiple regression analysis showed that the strongest hormone correlates of pubertal development were androgen levels (primarily testosterone in boys and primarily dehydroepiandrosterone sulphate and androstenedione in girls). Estradiol level in girls was the strongest correlate only for menarchial status. Level of testosterone-estradiol binding globulin, which was lower at successive pubertal stages for boys and showed no consistent differences for girls, may be a useful measure for studying the developmental processes and gender differences during puberty.

Developmental processes in early adolescence: relationships between adolescent adjustment problems and chronologic age, pubertal stage, and puberty-related serum hormone levels

Relations between adolescent psychosocial adjustment problems and markers of biologic development, including chronologic age, pubertal status, and serum hormone levels, were examined in 56 normal boys and 52 normal girls, ages 9 to 14 years. Adolescent psychosocial adjustment was assessed by adolescent self-ratings of various aspects of self-image (Offer Self-Image Questionnaire for Adolescents) and parent ratings of adolescent behavior problems (Child Behavior Checklist). The pubertal status measure used in the analyses was Tanner genital stage for boys and Tanner breast stage for girls. The hormone measures, determined by radioimmunoassay, were serum levels of gonadotropins (luteinizing hormone and follicle stimulating hormone), sex steroids (testosterone and estradiol), and adrenal androgens (dehydroepiandrosterone and its sulfate, and androstenedione). The testosterone/estradiol ratio also was computed. Overall, findings were stronger, more consistent, and more generalized for boys than for girls. For boys, adjustment problems typically were associated with a multivariate profile that may be characteristic for later maturers: relatively low sex steroid levels, or lower pubertal stage, and relatively high adrenal androgen (androstenedione) levels, frequently in conjunction with higher chronologic age. Univariate relations predominated for girls; that is, associated with adjustment problems for girls were relatively high levels of gonadotropins, relatively low levels of dehydroepiandrosterone sulfate, and relatively high levels of androstenedione on their own or in conjunction with lower pubertal stage. Higher levels of androstenedione, a steroid particularly responsive to stress, were associated with adjustment problems in both boys and girls. This relation may reflect the stress of later maturation, which could result from environmental factors, such as adolescent self-comparisons with same-age peers, or endogenous effects of hormones.

The role of steroid metabolic profiling as an aid in the diagnosis of familial precocious puberty, a subgroup of true precocious puberty

We report the results of a study of a rare form of true precocious puberty in a family with a history of the condition. Only the male members manifest the trait, whereas it appears to be carried by both males and females. Routine urinary steroid analysis rapidly eliminated most of the classical enzyme defects associated with premature sexual maturation. Further investigation of urinary steroid extracts using gas chromatography and gas chromatography-mass spectrometry revealed essentially normal prepubertal androgen values for the proband A at 4 years of age, and for his affected and carrier relatives when compared with healthy age-matched individuals. While his plasma gonadotropin levels were in the prepubertal range, his plasma testosterone value was significantly elevated with values just below the normal range for an adult male. This is the fourteenth reported family with a vertical pattern of familial sexual precocity, but the first to have a steroid profile. Analysis suggests sex-limited autosomal dominance with a greater than 90% penetrance. The elevated plasma testosterone concentration, prepubertal plasma gonadotropin concentration, minimal histopathologic evidence of gametogenesis and only moderate increase in testicular volume over the five-year course of follow-up support a diagnosis of the recently described condition of familial gonadotropin independent sexual precocity. The gas chromatography-mass spectrometry urinary profiling shows elevated cortisol output but otherwise normal adrenal function.

Pubertal development: normal, precocious and delayed

The present concepts on the neuroendocrine mechanisms which trigger pubertal development and modulate the progression towards sexual maturity have been reviewed. Essentially, puberty is presented as a continuum, the programming of which is initiated prenatally and which ends in adult life when all hormonal secretions become autoregulated. This continuum is dependent on a delicate equilibrium between CNS neurohormones (GnRH), neurotransmitters (biogenic amines), pituitary gonadotrophin (FSH, LH) secretion and the end-organ response (testis or ovary) through the activation of specific membrane receptors. The gonadal sex steroids (T, OE2) will activate specific cytoplasmic and nuclear receptors of target tissues and exert their biological action. Initially, the activity of the HPGA is manifested by nocturnal LH peaks, followed by increased gonadal secretion of T or OE2. Extremely sensitive to negative feedback by circulating androgen and/or oestrogen in prepuberty, an hypothalamic regulatory system called the gonadostat increases its threshold of sensitivity and eventually becomes autoregulated at a higher feedback level. Progressively, the hypothalamus becomes sensitive to positive feedback action of gonadal hormones, this phenomenon being important for the onset of ovulation. It is likely also that adrenal androgens play a permissive and supportive role in the onset and progression of pubertal development. Finally, full maturity is reached, with final adult height through fusion of the epiphysis, and fertility is achieved. The clinical manifestations of each developmental stage of puberty are described and abnormalities of sexual development reviewed. While over 90 per cent of cases of precocious pubertal development are idiopathic in girls, a space-occupying lesion in the hypothalamic-pituitary region is frequent in boys. Dissociated pubertal signs (premature adrenarche, pubarche, thelarche, menarche) are discussed, together with diagnosis and treatment of precocious puberty, whether it is idiopathic or occurring independently of the activation of the HPGA. In addition to delay of puberty on a constitutional basis, or related to chronic endocrine or non-endocrine diseases, the main clinical entities with gonadal insufficiency, primary (hypergonadotrophic) or secondary (hypogonadotrophic), are reviewed in boys and girls and their investigation and treatment discussed.

Effect of puberty on rates of bone growth and mineralisation: with observations in male delayed puberty

The bone mineral content (BMC) and body height were measured in 301 normal children and adolescents aged 7--20 years, and in 8 boys with constitutional delayed puberty aged 14--17 years. Serum testosterone was measured in the last group as well as in a subpopulation of the normal children and adolescents. The growth spurt, which coincided with a steep increase of serum testosterone in boys, indicated a great change in skeletal growth and mineralisation in both sexes. After the growth spurt, linear growth slowed down considerably while bone mineralisation rose steeply. When low levels of serum testosterone were maintained, as in delayed puberty, these combined changes of skeletal growth and mineralisation did not occur. It is suggested that gonadal hormones are the true initiators of the short-lived growth spurt as well as of prolonged acceleration of bone mineralisation.

Adolescent breast masses

A retrospective experience with breast masses in 143 female and 22 male adolescents is reviewed: 104 females (71.7 per cent) had fibroadenomas and 1 (0.7 per cent) adenocarcinoma; all 22 males had gynecomastia. The significance of these findings is related to surgical therapy.

Steroids after birth-puberty

The production of gonadal steroids in the perinatal period may have an important influence on the later development of the hypothalamo-pituitary-gonadal axis. In the prepubertal period there is an increased output of gonadal steroids and of androgens from the adrenal cortex, with a further increase as the secondary sex characters develop. The precise role of individual steroids in the maturation of the reproductive system and of the neuroendocrine regulating mechanisms will probably remain unclear unless conclusions are based on longitudinal studies in which hormone production is related precisely to different parameters of sexual development and somatic growth.