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BOOK TITLE: Principles and Practice of Assisted Reproductive Technology
The term puberty is used to designate the maturation of the reproductive axis, the development of secondary sex characteristics and the attainment of the ability to reproduce. Puberty is a dynamic process which is brought about by a cascade of events culminating in the eventual episodic secretion of gonadotropin-releasing hormone (GnRH) from hypothalamus. It is a process which is finely regulated by genetic, neuronal, environmental and metabolic factors. This chapter covers the hypothalamic-pituitarygonadal axis, menstrual cycle, neuroendocrine control of onset of puberty, genetic factors controlling pubertal onset, nutritional determinants of the timing of puberty, stages of pubertal development, normal variants of puberty, disorders of puberty, delayed puberty, and growth problems in normal adolescents. Delayed puberty is defined as the lack of pubertal development by an age that is 2–2.5 SDs later than the average, traditionally by the absence of development of secondary sexual characteristics by age 13 years in girls (absent breast development) or age 14 years in boys (no testicular enlargement).