11.1 Puberty Flashcards
what is thelarche?
onset of breast development
what is pubarche?
onset of sexual hair development
how are pituitary gonadotropins secreted?
- pulsatile
- oestrogens
- androgens
puberty control centres in order?
- higher centres
- hypothalamus (GnRH)
- pituitary (LH, FSH)
- gonads
what is adrenarche?
- increased adrenal androgen production in both sexes
- happens before gonadarche
- not true puberty
growth spurt for girls v boys?
- 5 years - girls
13. 5 years - boys
what to think about in early sexual development?
- central v peripheral causes
- complete v incomplete
- pathological v normal
what is true precocious puberty?
- problem with central activation
- check LH, FSH, sex steroid levels
- can be neuro tumours
- mostly idiopathic
precocious pseudo-puberty is?
- peripheral activation
- congenital adrenal hyperplasia
- tumours
- iatrogenic
what are normal variants in early sexual development?
- premature thelarche
- premature adrenarche
lower limits of normal for development for girls?
<8 thelarche, pubarche
<10menarche
lower limits of normal for development for boys?
- testicular enlargement 9 years
- pubic hair 9years
early puberty, what bloods?
- LH, FSH, testosterone, oestradiol, prolactin, hCG
- DHEAS, androtenediaon, 17-OH progesterone
what causes precocious puberty?
girls: 90% idiopathic
boys: 75% HAVE a pathological CNS lesion
how to treat central precocious puberty?
- treat CNS tumour
- pubertal suppression
how to suppress puberty?
GnRH agonists
-depot injections 4-12 weeks
what is McCune-Albright syndrome?
- peripheral, not central
- more in girls than boys
- low LH and FSH but high pubertal sex steroids
- has skin lesions
- x-ray have polyostotic lesions
how to treat McCune-Albright syndrome?
peripheral hormone blockade: aromatase inhibitors
thelarche normal variant?
- common first 2 years of life
- fluctuates
- ?exogenous oestrogen exposure
- usually bone age is normal
what to look out for in premature adrenarche?
early pubic hair:
<8 girls, <9boys
-oily skin, mild acne, axillary hair, adult body odour
when are ovarian cysts abnormal?
> 10mm, exaggerated follicular, sometimes with haemorrhage
-monitor with U/S
pubertal gynaecomastia common in boys?
~50% in boys peak age 14
- investigate if
- exaggerated
- abnormal progression
- associated signs
pathological gynaecomastia?
drugs - marijuana
- sex-steroid tumours
- klinefelter
- systemic illness
when is delayed puberty?
13 for girls
14 boys
when is puberty delayed in terms of menarche?
15.5-16y
what is arrested puberty?
> 5yrs with incomplete progression
causes of delayed puberty?
gonadal (primary)
pituitary (secondary)
hypothalamic (tertiary)
Primary hypogonadism causes?
- chromosomal
- trauma/torsion
- radiation, chemo
- cryptorchidism
Primary hypogonadism Ix features?
- high LH, LSH
- low testosterone/oestradiol
secondary hypogonadism causes?
- craniopharyngioma
- trauma
- radiotherapy
- genetic pituitary
secondary hypogonadism Ix features?
- low LH, LSH - evena fter GnRH
- low testosterone/oestradiol
tertiary hypogonadism causes?
familial (normal variant)
- lesions
- genetic GnRH neurone migration
- Kallmann syndrome (anosmia)
tertiary hypogonadism Ix features?
- low LH, LSH -
- BUT rise after GnRH stim
- low testosterone/oestradiol
what is constitutional delay?
most common: boys >girls
- slow growth
- delayed bone age: >2yr
- no pathological
- often FHx
- reassure
