Follicle-Stimulating Hormone (FSH) and the Onset of Puberty
Follicle-Stimulating Hormone (FSH) and the Onset of Puberty
The purpose of this study is to determine if the timing of the onset of puberty may be
 affected by FSH-regulatory peptides.

 We will determine how these peptides relate to FSH production in prepubertal and pubertal
 children by comparing the regulation of FSH control in children with precocious (early)
 puberty and delayed puberty.

 In this pilot study, we will stimulate the pubertal axis using an agonist of GnRH to
 determine the pubertal response of activin-A, inhibin-A and -B and follistatin.

 To determine baseline FSH secretion and FSH-regulatory peptide tone, we will block GnRH with
 a specific antagonist.

 These studies should lead to a better understanding of the role of FSH in controlling the
 onset of puberty and the pathogenesis of pubertal disorders.
Girls begin puberty earlier and have as much as a 5-fold increase in incidence of precocious
 puberty as do boys, while boys are more likely to have delayed adolescence compared to girls.

 The reasons for sex differences in the timing of puberty and sex-based variation in
 expression of pubertal disorders are not known.

 Puberty is heralded by an increase in the episodic release of luteinizing hormone (LH) under
 the control of increased gonadotropin-releasing hormone (GnRH) release. It has been thought
 that sex differences in central nervous system restraint of GnRH and subsequently of LH
 secretion account for the differences in timing of onset of puberty in boys and girls.

 Follicle-stimulating hormone (FSH) secretion is readily detected prior to the onset of
 puberty and exhibits sexual dimorphism in basal and GnRH-stimulated concentrations. Thus,
 assessment of factors regulating FSH secretion during childhood may enhance our understanding
 of sex differences in pubertal development and the pathogenesis of precocious puberty.

 Although FSH is secreted under the control of GnRH, FSH is also secreted constitutively under
 the control of a group of peptides collectively known as the FSH-regulatory proteins. These
 peptides include activins, peptides that increase FSH secretion and inhibins and
 follistatins, peptides that suppress FSH secretion.

 Gonadal inhibins inhibit FSH via endocrine negative feedback, but their production during
 puberty is only beginning to be understood. Activin and follistatin have been thought to have
 a principle paracrine role in FSH regulation but recent data have demonstrated these peptides
 have an endocrine role as well.

 We hypothesize that differences in elaboration of activins, inhibins, and follistatin that
 alter FSH constitutive secretion underlie precocious and delayed puberty in boys and girls
 and account, in part, for sex differences in pubertal timing.

 Specifically we expect that the inhibitory regulators, inhibins and/or follistatins, will be
 lower while the stimulatory regulator, activin, will be higher in early compared to delayed
 puberty.

 FSH and the Onset of Puberty is a case control study comparing boys with precocious puberty
 to boys with delayed adolescence and girls with precocious puberty to girls with delayed
 adolescence.

 Hypothesis: Basal and GnRH agonist-stimulated activin concentrations will be greater and
 inhibin concentrations lower in children with early puberty than in children with delayed
 adolescence, and the GnRH antagonist, ganirelix, will decrease activin concentrations in
 children with early puberty but not in delayed adolescence.

 Specific Aim 1: Determine the degree to which FSH-regulatory peptides, compared to
 gonadotropin-releasing hormone (GnRH), control FSH secretion in children by suppressing GnRH
 with ganirelix in children with early and delayed adolescence.

 Specific Aim 2: Determine the role of FSH-regulatory peptides in control of timing of onset
 of puberty by comparing their concentrations with and without GnRH stimulation of FSH in
 children with precocious puberty and delayed adolescence.

 Specific Aim 3: Determine the role of GnRH in control of the FSH-regulatory peptides by
 comparing activin, inhibin and follistatin concentrations in children with delayed
 adolescence due to constitutional growth delay to those with delayed adolescence from
 hypogonadotropic hypogonadism
Inclusion Criteria:

 Early Puberty Children who have early puberty may participate in this study. Children must
 be between 6 and 10 years of age and be healthy with the exception of having early puberty.
 For early puberty, girls should have had the onset of breast development prior to 8 years
 of age and boys should have the onset of pubic hair growth or genital growth prior to 9
 years of age.

 Inclusion Criteria for Delayed Puberty Children who have late (delayed) puberty may
 participate in this study. Children must be between 12 and 17 years of age and be healthy
 with the exception of having late puberty. In order to have late puberty, boys and girls
 should have short stature compared to their family with at least one year delay in bone age
 as determined by bone age x-ray and/or have the onset of secondary sexual characteristics
 (breast and pubic hair growth) at 12 years of age or later for a girl or 13 years of age or
 later for a boy.

 Exclusion Criteria:

 Early Puberty Children with known genetic disorders, chronic medical conditions requiring
 the use of steroids, and use of medication for puberty within the last 3 months are
 excluded.

 Delayed Puberty Children with known genetic disorders with the exception of possible
 hypogonadotropic hypogonadism, chronic medical conditions requiring the use of steroids,
 and use of medication for puberty within the last 3 months are excluded.

 -