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Abnormalities in Puberty: Scientific and Clinical Advances
http://www.100md.com 《新英格兰医药杂志》
     This volume in the Endocrine Development series is a collection of state-of-the-art reviews, plus two chapters presenting original data. All chapters but one originate from European centers, and all authors are well respected in their fields.

    There is a perception in the United States, not accepted by all, that puberty now starts at an earlier age than it did a few decades ago. In the introductory chapter, Delemarre-van de Waal reports that the age of puberty is stable in Europe, with some areas actually reporting a later age of onset than has been reported in the past. She also reviews genetic and nutritional influences on the process. Karges and de Roux pursue the genetic theme with isolated hypogonadism, bringing the reader up to date on all the reported mutations of the hypothalamic–pituitary axis.

    With glucocorticoids being given to mothers of children who may be delivered prematurely and to mothers of children with virilizing congenital adrenal hyperplasia, and with cortisol levels increasing in neonates under stress, a question arises as to whether such factors affect the age of onset of puberty. Ong discusses the present understanding of the effects of fetal and neonatal glucocorticoid physiology on puberty, using information derived from studies of children and animals. Delemarre-van de Waal and her colleagues present data from their longitudinal observations of children who were small for gestational age at birth, as well as results from studies of puberty in rodents with fetal undernutrition. Polycystic ovary syndrome is one of the constellation of disorders that occur in small-for-gestational-age children, and Homburg reviews the diagnosis, pathophysiology, and treatment of polycystic ovary syndrome, emphasizing the need for a high index of suspicion in cases of persistent oligomenorrhea or other manifestations of excessive androgen production in teenage girls.

    Jung and colleagues present a thorough review of what is known and what is postulated concerning the relation between hypothalamic hamartomas and precocious puberty. Since medical therapy is recommended for these masses in sensitive locations of the central nervous system, the chapter by Heger and colleagues on 20-year outcomes of treatment with gonadotropin-releasing hormone agonists is a welcome addition and a demonstration of the many beneficial effects of treatment in appropriately selected subjects (their list of indications for treatment is also practical). Johansson and Ritzén present several decades of follow-up data on the psychosocial effects of early menarche (that occurring before 11 years), which suggest more norm-breaking behavior during adolescence and lower educational levels later, all apparently related to initiation of sexual activity at a young age as a result of early development.

    Bone health is important for all young people, especially in this age of inadequate calcium and vitamin D intake by children. Vanderschueren and colleagues review the latest knowledge about bone density in people with various forms of gonadal failure and the effects of therapy, and they discuss delayed puberty in the context of calcium and vitamin D intake. It has now been well over 50 years since glucocorticoid therapy for congenital adrenal hyperplasia was first used; Otten and colleagues review the results of this treatment on growth, puberty, and subsequent fertility in children with this disorder. Remarkable successes in cancer therapy allow us to turn attention to previously unthinkable issues, such as fertility in survivors of childhood cancer. Beerendonk and Braat review the effects of radiation and chemotherapy on future fertility and many aspects of the preservation of fertility, ranging from ovarian transplantation to cryopreservation of ovarian tissue or ova.

    Although there are variations, the overarching themes of the book are the long-term effects of fetal life on puberty and the long-term effects of puberty on later life. Although a book of this size cannot fully cover all aspects of pubertal development, the chosen aspects are of importance to clinicians, and the often encyclopedic references will be of use to researchers in the field as well.

    Dennis M. Styne, M.D.

    University of California, Davis, Medical Center

    Sacramento, CA 95817

    dmstyne@ucdavis.edu((Endocrine Development. V)