What happens in the brain during puberty?

During the sensitive psychological and physical developmental period of puberty, a number of disease patterns occur that require medical intervention. High growth is understood to be when the person concerned is taller than 96% of all peers. In most cases, the cause is a family predisposition.

In this case, therapy is carried out with female sex hormones (estrogens, gestagens), as these accelerate bone maturation and thus lead to an early termination of bone growth. However, the therapy must be carried out before the growth spurt if the bone age is less than 12 years. This means that the X-ray image shows a developmental stage of bone growth as is common before the age of 12.

After about 2 years of therapy, the treatment can be terminated. The bone age should be about 15.5 years (the child is younger). Mood swings and emotional outbursts are normal during puberty.

There are not only hormonal and physical changes, but the adolescents also grow up mentally slowly. During this development, the adolescents react very sensitively and emotionally to stress and criticism, while they themselves are very critical of their bodies. In some adolescents, these mood swings take on pathological proportions and they develop depression.

Depression is the most common mental illness in Germany and in half of the cases this illness begins already in puberty. A depression differs from a depressive mood mainly by the duration of the symptoms. Girls are affected twice as often as boys.

Teenagers report an inner emptiness, joylessness and low self-confidence, even suicidal thoughts. Depression in adolescence is often accompanied by other mental illnesses. These include anxiety disorders, social disorders, drug abuse and eating disorders.

Over 80% of depressions are curable. In most cases, a combination therapy of psychotherapy and medication is best suited. The aim is to reduce tension and restore self-confidence.

Depression is a serious illness and not just an episode that subsides again. It is a premature onset of puberty with development of the secondary sexual organs before the age of 8. The premature growth spurt leads to a premature growth termination with a reduced final size.

In real pubertas praecox the cause is often in the brain. It can also occur following accidents or inflammation – often no cause can be found. The therapy is carried out with so-called GnRH analogues, which reduce the production of sex hormones and thus can postpone puberty.

In this way, small growth can usually be prevented. Pseudopubertas praecox is often caused by tumors of the ovaries or adrenal gland tumors. Other disorders can also be the cause.

In this case, the therapy must treat the causal disorder after thorough diagnostics. Incomplete pubertas praecox is described as when only the first menstruation, breast development or hormone release from the adrenal cortex begins prematurely. No therapy is usually necessary here.

Pubertas tarda represents a delay in the onset of puberty, with absence of the first menstrual period up to the age of 16 or absence of any signs of puberty up to the age of 14. The most common cause is the maldevelopment of the sexual organs with a lack of function of the ovaries, such as in the Ulrich-Turner syndrome. The brain can also be the cause.

Tumors and underfunctioning of the pituitary gland (hypophysis) as well as Kallmann syndrome are particularly noteworthy. Eating disorders, competitive sports and severe underlying diseases can also massively affect the beginning of puberty. A chromosomal analysis is performed to exclude Turner syndrome.

A so-called GnRH test is carried out to determine the function of the brain with regard to hormone balance. Therapeutically, after the treatment of the underlying disease, the focus is on the replacement of the female sex hormones by medication. A gynecomastia is a growth of the breasts in men.

This can have both pathological and normal causes. Puberty gynecomastia is a normal variant of gynecomastia.This affects about half of all boys in adolescence and usually regresses within two to three years. Gynecomastia must be distinguished from pure fat accumulation in the breast area, which occurs in overweight boys.

In rare cases, pubertal gynecomastia does not regress in adulthood. In cases of great suffering, the mammary gland can be surgically removed. In any case, however, a more detailed examination must be carried out to exclude pathological processes.

First of all, a palpation examination is performed and an ultrasound is performed. Pubertal gynecomastia can also occur on one side only. Physical symptoms can be a feeling of tension and sensitivity to touch.

Much more important, however, is the mental strain of the adolescent. The increased influence of male sex hormones (androgens) causes this skin disease in about three quarters of all pubescent patients. Affected are the sebaceous glands, which become clogged by increased sebum production and excessive hornification.

Initially blackheads (comedones) form, which heal without scarring. If these blackheads become inflamed, papules and pustules (“pimples“) develop, which leave scars after healing. In addition to the male sex hormones, smoking, stress and incorrect skin care products also have a beneficial effect on acne development.

In addition to the physical complaints, severe acne in particular causes psychological stress for young people. The treatment should be placed in dermatological hands (dermatologist). The treatment with the fruit acid alpha-hydroxy acid as well as with salicylic acid is available, with which the skin appearance can be improved by regular peelings.

Antibiotics should be used if severe inflammation is present. Benzoyl peroxide has an antibacterial effect and dissolves the horny layer, so that excessive sebum can be removed. The use of linoleic acid and vitamin A acid also helps well against acne symptoms.

In particularly severe cases, the intake of isotretinoins can provide relief. As a rule, however, acne can be expected to disappear at the age of early twenties. As the hormones in the body change, the composition of the skin also changes.

In children, the water content of the skin is very high and the fat content is rather low. With the beginning of puberty, the amount of fat in the skin increases and skin impurities occur. The sebaceous glands produce more sebum and at the same time a thickened horny layer forms on the skin.

This horny layer can close the sebaceous glands, so that sebum accumulates underneath. When manipulated from the outside, these sebaceous glands can become inflamed and grow in size. The male hormone testosterone is responsible for the skin changes in puberty.

This is why male teenagers often have to fight acne even more than their female peers. In many cases, acne diminishes when the hormones are brought into balance at the end of puberty. The main problem with pubertal acne is that teenagers are psychologically sensitive and therefore often suffer from pimples and permanent scars.

In the case of severe acne, however, a significant improvement can be achieved with medication. Due to the changes in the female body in favor of curves, young girls can easily experience rejection reactions. If further psychological conflicts or even bad sexual experiences occur, an eating disorder can result.

Typical eating disorders that can develop are Anorexia nervosa (anorexia nervosa) is caused by massively restrictive eating habits, vomiting, the use of laxatives or appetite suppressants as well as excessive sport. By definition, the body mass index (BMI, body weight in kilograms divided by height in m) is below 17.5 for anorexia nervosa. The low body fat content leads to the absence of menstruation (amenorrhoea).

This life-threatening clinical picture should never be suppressed or played down. Psychotherapy should be initiated as soon as possible. In bulimia, eating attacks with subsequent vomiting occur.

The stomach acid causes massive damage to the teeth. The salivary glands swell and electrolyte leakage can have dangerous consequences. Bulimia often develops from anorexia when the craving for food takes over.

Psychotherapy is also urgently needed here.Binge eating disorder is an eating attack without subsequent vomiting. Overweight is the logical consequence.

Anorexia nervosa
Bulimia
Binge Eating Disorder