To Örebro University

Puberty is initiated by a series of complex mechanisms determining the age at pubertal onset. The aim of this thesis was to increase our knowledge of the role of ghrelin and kisspeptin in puberty, to describe the clinical management of delayed puberty and to study the long-term socioeconomic consequences of delayed male puberty.

Study I and II were both based on a population of 13 girls with suspected central precocious puberty, who underwent a modified gonadotropin-releasing hormone stimulation test twice in a randomized controlled setting. Neither ghrelin nor kisspeptin plasma levels differed between the two tests up to 150 minutes. In Study I, different methods for the preservation of acylated ghrelin were studied as well, and the addition of the protease inhibitor AEBSF to precooled bloodsampling tubes, and cooled centrifugation within 30 minutes were found to result in the highest levels of acylated ghrelin.

Study III was an observational study based on a review of the medical records of 91 boys with delayed puberty in central Sweden showing that puberty nomograms are useful diagnostic instruments, and that underlying pathology is rare but psychosocial distress is common.

Study IV was a longitudinal, retrospective national cohort study, which included 1,250 men previously diagnosed with delayed puberty and 12,500 unexposed men. There was a lower likelihood of marriage or cohabitation, but no negative effects on educational achievements or labour market outcomes through early adulthood among those having had delayed puberty.

Increased knowledge of the physiology and long-term consequences alterations in pubertal timing may improve the management of pubertal