21. Puberty Disorders of Development Flashcards
(38 cards)
In the anterior lobe of the pituitary, one can find FSH and LH which are synthesized and stored in cells called gonadotrophs
MEOW
Ovarian cycle is divided into follicular phase which begins with onset on menstruation and culminated in the preovulatory surge of LH and Luteal phase which begins with the onset of preovulatory surge of LH and ends with the first days of?
Menses
Decreasing estradiol and progesterone from regressing corpus luteum initiate an increase in FSH by a negative feedback mechanism, which stimulates follicular growth and estradiol secretion… major characteristic of follicular growth and estradiol secretion is explained by?
FSH and LH
LH stimulates theca cells to produce androgens (testosterone and androstenedione) and FSH stimulates the granulosa cells to covert the androgens to?
Estrogens E1/E2
During Luteal phase, LH and FSH are suppressed via negative feedback due to elevated estradiol and progesterone, in no conception occurs, E/P decline due to regressing corpus luteum near the end of luteal phase, FSH will then rise to initiate new?
Follicular Growth
GnRH (Gonadotropin-Releasing Hormone) in the hypothalamus (arcuate nucleus) is responsible for synthesis and release of LH and FSH, it does so by reaching the anterior pituitary and stimulating its synthesis and release, what enhances hypothalamic release of GnRH?
Estradiol - so induces midcycle LH surge
During follicular development, ovary secretes minimal progesterone, most of it comes from conversion of adrenal pregnenolone, prior to ovulation the unruptured luteinizing graafian follicle begins to produce inc. progesterone. secretion of progesterone by the corpus luteum reaches a max at how many days after ovulation and returns to normal before mesntruation?
5-7 days (same time as estrogen)
Endometrium divided into 2 zones: outer functionalis- sprial arteries (sloughed off), and inner basalis- unchanged during each cycle containing basal arteries… Endometrial stages are menstrual phase, proliferative phase (estrogenic) and the?
secretory phase (progestational)
Menstrual phase is the only portion of the cycle that is vizualized, first day is cycle day 1, sloughing off functionalis layer, proliferative phase- endometrial growth due to estrogen stimulation- inc in length of spiral arteries and numerous mitoses, glands are straight, folowing ovulation, progesterone secretion by corpus luteum stimulate gland cells to secrete mucous and gylocen, what phase?
secretory phase
In secretory phase, stroma is edmatous, mitosis are rare, spiral arteries continue to extend into endometrium, glands are tortuous, endometrial lining is max thickness at 18mm (should be less than 4mm in postmeno women), no conception by day 23, corpus luteum regresses and secretion of what declines?
estradial and progesterone
1 day prior to menstruation: constriction of spiral arteries causing ischemia of endometrium
Menarche is 12.43 years, 10% at 11.11 years, 90% at 13.75 years, occurs 2-3 years after thelarche at tanner stage IV, what is it called when there is no menstruation by 13 years old WITHOUT secondary sexual development or by the age of 15 WITH secondary sexual characteristics?
Primary Amenorrhea
First year of cycls are usually 21-45 days (avg34days), by 3rd year most are between 21-35 days, first year flow is less than 7 days and the amount of tampons used per day should be between 3 and?
6
Median blood loss per period is 30cc, greater than 80cc is assoc with anemia-changing pad q1-2 hours is excessive especially if bleeding lasts longer than 7days. Puberty is usually at 12.4 years and depends on race, urban, and obese/malnutrioned will be early?
Obese have earlier onset
Malnutrioned later onset
(106lbs mean weight of menarche)
Around 11, there is a loss of sensistivity by the gonadostat to the negative feedback of sex steroids, in combo with the intrinsic loss of CNS inhibition of hypothalamic GnRH release. increase in GnRH promotes ovarian follicular maturation and sex steroid production which elads to development of ?
secondary sexual characteristics
Thelarche is the first sign of puberty (requires estrogen), unliateral is normal, Adrenarche (pubarche) (requires androgens) is the growth of pubic hair/axillary hair development, peak height velocity occurs 2 years earlier than men and then menarche occurs which requires PULSATILE GnRH from hypo, FSH and LH from pit, estrogen and progesterone from ovaries and a normal?
outflow tract
all these happen earlier in AA and earliest in hispanic
match the following Tanner stages for breast growth…
Stage 1
Stage 2
Stage 3
Stage 4
Stage5
preadolescent: elevation of papilla only
mature: projection of papilla only, resulting from recession of areola to the general contour of breast
Futher enlargment of breast and areola without separation of their contours
breast bud- elevationof breast and papilla as a small mound w enlargement of areolar region
projection of areola and papilla to form a secondary mound above the level of the breast
Stage 1 preadolescent: elevation of papilla only
Stage 2 breast bud- elevationof breast and papilla as a small mound w enlargement of areolar region
Stage 3 Futher enlargment of breast and areola without separation of their contours
Stage 4 projection of areola and papilla to form a secondary mound above the level of the breast
Stage5 mature: projection of papilla only, resulting from recession of areola to the general contour of breast
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
absence of hair
adult type hair with spread to medial thighs assuming inverted triangle pattern
adult type hair, no spread to medial surface of thighs
hair spreads sparesly over juncction of pubes; darker and coarser
sparse hair along labia, hair downy with slight pigment
Stage 1 absence of hair
Stage 2 sparse hair along labia, hair downy with slight pigment
Stage 3 hair spreads sparesly over juncction of pubes; darker and coarser
Stage 4 adult type hair, no spread to medial surface of thighs
Stage 5 adult type hair with spread to medial thighs assuming inverted triangle pattern
Precocious puberty occurs at 8 for girls and 9 for boys and can be caused by heterosexual- development of opposite sexual characteristics (virulizing tumors, CAD) or isosexual- development of?
sexual maturation that is appropriate for pphenotype of affected individual (tumors, trauma, infectious)
Heterosexual precocity is due to andorgen secreting neoplasms such as sertoli leydig cells or adrenals, What is MC result from defect of the adrenal enzymes 21-hydroxylase leading to excessive androgen production, present with birth of female w ambiguous genitalia w progressive virilization and short adult status?
Congenital Adrenal Hyperplasia CAD
True isosexual precocity means premature activation of normal process while pseuoisosexual precocity is caused by estrogen producing tumors. True - 75% idiopathic, dx with admin of GnRH see rise in LH (tx with GnRH agonist) Pseudo is due to McCune Albright Syndrome and?
Puetz Jegher syndrome
McCune Albright Syndrome involves somatic mutation during embryogenesis which causes them to function independent of normal sitmulating hormones, cystic bone defects, cafe au lati spots (face neck shoulder and back) and will see adrenal hypercortisolism. In puetz jegher associated with sex cord tumor that secretes estrogen and GI polyps with what skin lesions?
Mucocutaneous pigmentation
Amenorrhea is absence of menses primary listed above, secondary is patient with prior menses has absent menses for 6 months or more
meow
Hypogonadotropic Hypogonadism (anorexia/Kallman)… Kallman syndrome is mutation of KAL gene on x chr that prevents migration of GnRH neurons into hypothalamus, patients have anosmia or hyposmia (cant smell)– these are diagnosed via low FSH LH and possible
MRI
primary ammenorrhea with absence of secondary sexual characteristics
Hypergonadotropic Hypogonadism (chr, inj to ovariy, chemo, radiation) test via MRI of brain, FSH, karyotype, progesterone and prolactin, find LH/FSH high, think TURNER SYNDROME 45XO: MC form of female gonadal dysgenesis, no signs of secondary sex characters, mosaicisim, see webbing neck, broad flat chest, short stature, streaked ovaries, no puberty and what of the heart?
Coarctation of the Heart
primary ammenorrhea with absence of secondary sexual characteristics
