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Puberty should not be considered as a de novo event but rather as a phase in the continuum of the development of gonadal function and the ontogeny of the hypothalamic-pituitary-gonadal system in the fetus, through puberty, to the attainment of full sexual maturation and fertility. By puberty, secondary sexual characteristics appear and the adolescent growth spurt occurs, which result in the striking sexual dimorphism of mature individuals, fertility is achieved, and profound psychological effects ensue.[1] These changes are a consequence of stimulation of the gonads by pituitary gonadotropins and increase in gonadal steroid output. Adolescence, a term usually considered to relate to the psychosocial aspects of the teenage years, is accompanied by the onset of adult patterns of sociosexual and economic behavior.[2]

The human being is the most reproductively successful of mammals, and many anthropologists have attributed this success to the prolonged pattern of human growth and development [3][4] and the delay in attaining full sexual maturity.[2][5] The evolution of the human scheme of growth involves the development of two stages: a childhood stage and an adolescent stage that includes an adolescent or pubertal growth spurt (Fig. 24-1). Not even our closest biologic relative, the chimpanzee, which matures twice as rapidly as the human, unequivocally exhibits these two stages including the unique human adolescent growth spurt.(The estimated date for divergence of the chimpanzee and human lineages is 4 million to 5 million years ago.)