Pubertal development is regulated by the hypothalamic-pituitary-gonadal (HPG) axis. Tanner staging ranges from 1 through 5 (with 5 being the most developed).With regards to pubic hair development, the scale goes as follows: Stage 1-no hair; 2-downy hair; 3-scant terminal hair; 4-terminal hair overlying the pubic triangle; 5-terminal hair extending to the thigh. With regards to male genitalia development, the scale goes as follows: 1-testes at the same size and proportion of early childhood; 2-enlargement of the scrotum/change in texture of scrotal skin; 3-growth of the penis length-wise; 4-growth of the penis in terms of length and circumference; 5-adult-sized genitalia. With regards to female breast development, the scale is as follows: 1-no palpable gland tissue; 2-palpable breast bud under areola; 3-breast tissue palpable outside of areola; 4-areola elevated above breast contour; 5-areolar mound recedes into single breast contour. The average age in which both males and females reach Tanner stage 5 of pubertal development is around 15–16. Neurological development
There are significant neurological changes that are expressed during preadolescence. White matter refers to the region of the nervous system corresponding to neuronal axons, which form fibers that convey information across different regions of the brain. In contrast, grey matter refers to the region of the nervous system corresponding to neuronal cell bodies, which process and relay neuronal signals. White matter volume increases at a relatively linear rate of about 12% from ages 4 through 22, specifically focused in the frontal, parietal, and occipital lobes.
Additionally, the sonographer can make an estimation of the amount of ascitic fluid, and difficult-to-drain ascites may be drained under ultrasound guidance. An abdominal CT scan is a more accurate alternate to reveal abdominal organ structure and morphology. Classification
Ascites exists in three grades:
Grade 1: mild, only visible on ultrasound and CT
Grade 2: detectable with flank bulging and shifting dullness
Grade 3: directly visible, confirmed with the fluid wave/thrill test

Pathophysiology
Ascitic fluid can accumulate as a transudate or an exudate. Amounts of up to 35 liters are possible. Roughly, transudates are a result of increased pressure in the hepatic portal vein (>8 mmHg, usually around 20 mmHg (e.g., due to cirrhosis), while exudates are actively secreted fluid due to inflammation or malignancy. As a result, exudates are high in protein and lactate dehydrogenase and have a low pH (<7.30), a low glucose level, and more white blood cells. Transudates have low protein (<30 g/L), low LDH, high pH, normal glucose, and fewer than 1 white cell per 1000 mm3. Clinically, the most useful measure is the difference between ascitic and serum albumin concentrations. A difference of less than 1 g/dl (10 g/L) implies an exudate.Portal hypertension plays an important role in the production of ascites by raising capillary hydrostatic pressure within the splanchnic bed. Regardless of the cause, sequestration of fluid within the abdomen leads to additional fluid retention by the kidneys due to stimulatory effect on blood pressure hormones, notably aldosterone.