Puberty and Tanner staging

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Puberty and Tanner staging


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Puberty and Tanner staging

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USMLE® Step 1 style questions USMLE

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A 12-year-old boy is brought to the physician for evaluation. During evaluation of sexual development of the boy, his genitalia and pubic hair are at Tanner stage 2 of sexual development. Which of the following characteristics are expected to be seen at this stage of sexual development?  

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GH secretion in p. 340

GnRH and p. 334

Kallmann syndrome and p. 663

precocious p. 55, 338

Tanner stages p. 660

Sexual development stages p. 660

Tanner stages (sexual development) p. 660


A long time ago, in an uterus far, far away, there was a sexually undifferentiated embryo, that could develop into either a male or a female according to its sex chromosomes.

During that time, most of its organs and systems took shape and started functioning.

But one system - the reproductive system - developed and then waited for a trigger to kick into action.

Even though we’re born with differentiated, male or female, sex organs, it’s not until puberty that they fully mature. That’s when an individual becomes capable of reproduction.

Sexual maturation is under the control of the hypothalamic-pituitary-gonadal axis.

The hypothalamic-pituitary-gonadal axis is a system of hormone signaling between the hypothalamus, pituitary gland, and gonads, either the testes or ovaries, to control sexual development and reproduction.

Gonadotropin-releasing hormone, or GnRH is released into the hypophyseal portal system, which is a network of capillaries connecting the hypothalamus to the hypophysis - or pituitary.

When gonadotropin-releasing hormone reach the anterior lobe of the pituitary gland, it stimulates cells called gonadotrophs, to release gonadotropin hormones: luteinizing hormone, or LH, and follicle-stimulating hormone, or FSH, into the blood.

These gonadotropin hormones then stimulate the gonads to produce sex specific hormones - which are estrogen and progesterone in females, and testosterone in males.

Now, the amount of hormone that gets produced by this axis varies over a person’s lifetime, and that affects the development of the sex organs, as well as the appearance of secondary sexual characteristics.


Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. During puberty, the sex organs mature functionally and begin producing sex hormones and gametes. It begins when the hypothalamus and the pituitary switch from a linear pattern of GnRH, FSH, and LH secretion to a pulsatile pattern.

In addition, in females, there's also a 28-day cycle of gonadotropin secretion called the menstrual cycle. The increased production of sex hormones determines the development of primary and secondary sex characteristics in both sexes, and these characteristics can be evaluated with the Tanner staging. The Tanner staging system consists of five stages, with stage 1 being the "pre-pubertal" stage, and stage 5 being the fully mature adult stage. Each stage is defined by specific physical characteristics: Stage 1: Pre-pubertal, no secondary sexual characteristics Stage 2: Beginning of breast development or testicular enlargement Stage 3: Further breast or testicular development Stage 4: Nearly mature; breast or testicular size nearly adult Stage 5: Adult; breast or testicles are fully mature


  1. "Medical Physiology" Elsevier (2016)
  2. "Physiology" Elsevier (2017)
  3. "Human Anatomy & Physiology" Pearson (2018)
  4. "Principles of Anatomy and Physiology" Wiley (2014)
  5. "Environmental Factors and Puberty Timing: Expert Panel Research Needs" Pediatrics (2008)
  6. "Growth and normal puberty" Pediatrics (1998)
  7. "Leptin, Growth Hormone, and the Onset of Primate Puberty" The Journal of Clinical Endocrinology & Metabolism (2001)
  8. "A Longitudinal Investigation of Associations Between Boys’ Pubertal Timing and Adult Behavioral Health and Well-Being" Journal of Youth and Adolescence (2006)

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