Carbohydrate counting

Abstract

Puberty is the stage of development leading to sexual maturation and reproductive potential. Normal puberty is regulated by the hypothalamic-pituitary-gonadal (HPG) axis which is activated at the onset of puberty from the quiescent prepubertal state. Precocious puberty is the onset of pubertal changes at an earlier age than is expected for the population. Precocious pubertal development may occur by either premature activation of the HPG axis (central precocious puberty) or exposure to endogenous or exogenous sex steroids independent of HPG axis activation (peripheral precocious puberty). Although some children evaluated for precocious puberty will have variants of normal development such as premature thelarche (breast development), pathologic causes will need to be ruled out in others (Kaplowitz, J Clin Endocrinol Metab 89(8):3644-3650, 2004).