When such patients reach a bone age of twelve to fourteen years for boys and eleven to thirteen years for girls, they begin to progress through puberty. At the time of presentation, these children rarely have any secondary sexual development, and their plasma gonadal steroids may likewise be prepubertal. However, as the bone age advances, levels of plasma gonadal steroids rise, increased LH secretion is noted (initially at night), and the entire pubertal process occurs.
