Over recent decades new insights have been obtained surrounding the concepts of the regulation of the onset of puberty. However, human puberty remains a mystery. The mechanisms responsible for suppression and reawakening of the GnRH pulse generator from fetal life into puberty still need to be elucidated. However, many genetic and environmental factors have been identified modulating the pubertal process.

This book on the abnormalities of puberty gives an overview on the latest knowledge in the physiology and pathophysiology of puberty and its disorders. Are there consequences for clinical practice on the findings of a continued trend of an earlier puberty in the United States? What are the underlying mechanisms of an early puberty in adopted children? We know that early growth, during the fetal period as well as during childhood, is able to program the central regulatory system related to growth, adrenarche and puberty. Endocrine and metabolic issues related to the 'developmental origin of adult disease' hypothesis and to the polycystic ovary syndrome are discussed. Abnormalities in GnRH release controlling genes are reviewed. The hamartoma, secreting GnRH, is described as a model of the onset of puberty. Experience on the application of GnRH analogues in the treatment of central precocious puberty as well as the psychosocial effects of an early puberty are extensively reported.

How should one treat the patient with gonadal failure with respect to bone development in order to prevent osteoporosis in later life and what are the future perspectives with respect to preservation of fertility in later life?

Recent clinical and fundamental data are described to give you an update on the new views on the control of puberty. We intend to support clinicians in the management of the child with too early onset of puberty, with delayed puberty and other pubertal disorders. Not only the clinical aspects, but also the aspects related to their causes such as early growth, and genetic and developmental defects are discussed, which may have consequences on final height, bone development and reproduction.

Henriette A. Delemarre-van de Waal

Delemarre-van de Waal HA (ed): Abnormalities in Puberty. Scientific and Clinical Advances. Endocr Dev. Basel, Karger, 2005, vol 8, pp 1-14

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