2025 – PAGE 59 – ADOLESCENT MEDICINE
Chapter 1: ADOLESCENT MEDICINE
PUBERTY
NOTES: Please note that there is a great deal of overlap and repetition between the puberty section and the Endocrinology section.
- Know conversion from inches to centimeters. 1 inch is about 2.5 cm!
- Sexual Maturity Ratings (SMR) and TannerStaging begins with ONE. There’s NO ZERO. Tanner/SMR 1 = Prepubertal
- Experts disagree regarding some SMR descriptions, and they definitely can’t agree on the age at which Delayed Puberty is diagnosed. Don’t stress! Questions on the exam should be fairly clear.
NORMAL PUBERTY TIMELINE
| SMR | Girls | Boys |
| Limits | Delayed Puberty: 13 – 14 yo
Precocious Puberty: 2° signs before 8 yo |
Delayed Puberty: 14 – 15 yo
Precocious Puberty: 2° signs before 9 yo |
| 1 | Basal growth at 5–6 cm/yr, boyish chest (papilla elevation only), no hair | <4 ml volume or <2.5 cm diameter of testicle, no hair, baby penis, basal rate of 5–6 cm/yr, no hair |
| 2 | Accelerated growth at 7–8 cm/yr, a breast bud is the 1st sign of puberty (palpable, areola enlarges), Hair only along the labia (coarse) | >4 ml or >2.5 cm (this is the 1st sign of puberty), hair at base of penis. Penis may start to enlarge (usually at SMR 3) |
| 3 | PEAK ht velocity of 8–10 cm/yr, elevation of breast contour, areola enlarges, curly hair at pubis, axillary hair begins, acne. This stage is similar to a boy’s SMR 3 + 4 combined. “Imagine a girl sitting on a 3-LEGGED STOOL crying because she has hair in her armpit and now has acne!” | Accelerated vertical (and penile) growth
>12 ml/3.5 cm, Gynecomastia in 50% of boys 10–16 yo, resolve in 3 yrs), CURLY hair at pubis. “Think about the 3 Stooges. They all had funny pubertal voices, and the fat one had BOOBS/GYNECOMASTIA and was named CURLY.” |
| 4 | Mound on mound, enlarged areola. Dense hair, none at the thigh. Menses usually occurs around SMR 3 or 4. | PEAK height velocity at 10 cm/yr, no thigh hair, develops AXillary hair, acne, and body odor. “Teenage boy with raging hormones is pissed about acne & hair so takes an AX to his 4 DOOR CAR (SMR 4) which explodes and burns his hair!” |
| 5 | Stop growing at about 16 yo, areola recesses to general contour of breast and the breasts again look like Tanner 3 | >4.5 cm penis, thigh hair, stop growing at ~17 or 18, +facial hair at sides, no more gynecomastia |