Published online February 1, 2008
PEDIATRICS Vol. 121 Supplement February 2008, pp. S218-S230 (doi:10.1542/10.1542/peds.2007-1813G)

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SUPPLEMENT ARTICLE

Public Health Implications of Altered Puberty Timing

Mari S. Golub, PhD^a,b, Gwen W. Collman, PhD^c, Paul M.D. Foster, PhD^d, Carole A. Kimmel, PhD^e, Ewa Rajpert-De Meyts, MD, PhD^f, Edward O. Reiter, MD^g, Richard M. Sharpe, PhD^h, Niels E. Skakkebaek, MD, DMSc^f and Jorma Toppari, MD, PhDⁱ

^a Department of Environmental Toxicology, University of California, Davis, California
^b California Environmental Protection Agency, Sacramento, California
^c Division of Extramural Research and Training
^d National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
^e National Center for Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Washington, DC
^f Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
^g Department of Pediatrics, Baystate Children's Hospital, Springfield, Massachusetts
^h Medical Research Council Human Reproductive Sciences Unit, University of Edinburgh, Edinburgh, Scotland
ⁱ Departments of Physiology and Pediatrics, University of Turku, Turku, Finland

Changes in puberty timing have implications for the treatment of individual children, for the risk of later adult disease, and for chemical testing and risk assessment for the population. Children with early puberty are at a risk for accelerated skeletal maturation and short adult height, early sexual debut, potential sexual abuse, and psychosocial difficulties. Altered puberty timing is also of concern for the development of reproductive tract cancers later in life. For example, an early age of menarche is a risk factor for breast cancer. A low age at male puberty is associated with an increased risk for testicular cancer according to several, but not all, epidemiologic studies. Girls and, possibly, boys who exhibit premature adrenarche are at a higher risk for developing features of metabolic syndrome, including obesity, type 2 diabetes, and cardiovascular disease later in adulthood. Altered timing of puberty also has implications for behavioral disorders. For example, an early maturation is associated with a greater incidence of conduct and behavior disorders during adolescence. Finally, altered puberty timing is considered an adverse effect in reproductive toxicity risk assessment for chemicals. Recent US legislation has mandated improved chemical testing approaches for protecting children's health and screening for endocrine-disrupting agents, which has led to changes in the US Environmental Protection Agency's risk assessment and toxicity testing guidelines to include puberty-related assessments and to the validation of pubertal male and female rat assays for endocrine screening.

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Key Words: puberty • precocious puberty • adrenarche • growth and development • breast cancer • testicular cancer • polycystic ovary syndrome • infertility • behavioral symptoms • risk assessment

Abbreviations: PCOS—polycystic ovary syndrome • HPG—hypothalamic-pituitary-gonadal • PA—precocious adrenarche • EPA—Environmental Protection Agency • MOA—mode of action

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Accepted Sep 5, 2007.

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