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Gynaecology > 3: Puberty and Pubertal Disorders > Flashcards

3: Puberty and Pubertal Disorders Flashcards

1
Q

Define puberty

A

Transition from non-reproductive to a reproductive state

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2
Q

What are the two events of puberty

A
  • Adrenarche

- Gonadarche

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3
Q

Define adrenarche

A

Formation zona reticularis

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4
Q

What does adrenarche enable

A

Release of DHEA and DHEAS

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5
Q

What age does adrenarche occur

A

6-8 years

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6
Q

Explain DHEA and DHEAS production

A

Increase until 15-years

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7
Q

Define pubarche

A

Clinical manifestation of adrenarche

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8
Q

What is gonadarche

A

Re-activation HPG axis

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9
Q

Explain gonadarche

A

Increase GnRH leads to increase LH and FSH - which cause spermatogenesis and oogenesis

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10
Q

What causes secondary sexual characteristics

A

LH causes release of testosterone from theca cells

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11
Q

When does puberty occur in females

A

8-14 years

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12
Q

When does puberty occur in males

A

10-16 years

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13
Q

Explain consonance

A

The events of puberty always happen in the same-order

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14
Q

If not in consonance what does it indicate

A

If events do not occur in the same order it indicates a pubertal disorder

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15
Q

What is the role of FSH

A

Increases oogenesis and spermatogenesis

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16
Q

What is the role of LH

A

Increases androgens and progesterone causing changes associated with puberty

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17
Q

What is the first-sign of puberty in females

A

Therlarche

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18
Q

Define therlarche

A

Formation breast buds

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19
Q

What is the usual age of thelarche

A

9-10 years

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20
Q

What is used to assess thelarche

A

Tanner staging

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21
Q

What is tanner stage 1

A

No breasts

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22
Q

What is tanner stage 2

A

Breast buds

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23
Q

What is tanner stage 3

A

Breast tissue extending beyond areolar

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24
Q

What is tanner stage 4

A

Secondary mound

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25
What is tanner stage 5
Full size
26
What is the second event of puberty in females
Pubarche
27
Define pubarche
Development of pubic hair
28
How long after pubarche does armpit hair grow
2-years
29
What mediates pubarche
Testosterone
30
What is the final event of puberty in females
Menarche
31
How many years after thelarche does menarche occur
3-years
32
Outline consonance of puberty in a female
Thelarche, Pubarche, Menarche
33
What is the first sign of puberty in boys
Testicular enlargement
34
What is role of LH in males
Increases testosterone produced by theca cells
35
What is role of FSH in males
Increases sperm production by Sertoli cells
36
What is used to assess change in testicular size
Tanner staging
37
What is tanner stage 1
1-3
38
What is tanner stage 2
4-9
39
What is tanner stage 3
10-14
40
What is tanner stage 4
15-20
41
What is tanner stage 5
>20
42
How long after testicular growth do boys experience first ejaculation
1-year
43
What is second step puberty in males
Pubarche
44
What controls growth
Sex steroids, GH, IGF-1
45
When do females have their growth spurt
12-years
46
When do Males have their growth spurt
14-years
47
Define precocious puberty for girls
Secondary sexual characteristics before 8 in girls
48
Define precocious puberty for boys
Secondary sexual characteristics before 9 in boys
49
In which gender is precocious puberty more common
Girls
50
What is central precocious puberty
Problem with gonadotrophin
51
What is peripheral precocious puberty
Problem with testes, adrenal gland or bHCG secreting tumour
52
How will GnRH present in central precocious puberty
Raised
53
What is the main cause of central precocious puberty
Idiopathic
54
What are two other causes of central precocious puberty
Congenital (eg. cerebral palsy) | CNS lesion
55
How will GnRH present in peripheral precocious puberty
Normal
56
How can peripheral precocious puberty be divided
Androgen raised | Oestrogen raised
57
What are 3 causes of increased androgens in peripheral precocious puberty
- CAH - Ovarian cysts - Leydig-cell tumour
58
What is most common cause of increased androgens peripheral precocious puberty
Ovarian cysts
59
What are 5 causes of precocious puberty with increased oestrogen
- Hypothyroidism - Obesity - Mccune albright - HCG secreting tumour
60
What does hypothyroidism cause
TSH increases FSH receptors
61
Explain precocious puberty in males
Precocious puberty is uncommon - usually has an organic cause
62
Explain precocious puberty in females
Precocious puberty is usually idiopathic or familial
63
Explain central precocious puberty and consonance
Follows consonance
64
Explain peripheral precocious puberty and consonance
Does not follow consonance
65
Explain growth in precocious puberty
Accelerated growth causes children to be taller during puberty. However, epiphyseal plates fuse pre-maturely causing them to be shorter in adulthood
66
If bilateral pre-mature enlargement of testes what does it indicate
Central precocious puberty
67
If unilateral pre-mature enlargement of testes what does it indicate
Peripheral precocious puberty
68
What do small testes indicate in precocious puberty
Adrenal cause
69
How will LH and FSH present in central precocious puberty
Raised
70
How will LH and FSH present in peripheral precocious puberty
Normal
71
How will oestrogen and progesterone present in precocious puberty
Normal
72
Why is TFTs taken in precocious puberty
To exclude peripheral precocious puberty
73
Why is an x-ray performed in precocious puberty
Examine bone maturation and fusion of epiphyseal plates
74
Why may pelvic US be taken
Look for pelvic mass
75
Why may cranial MRI be taken in precocious puberty
Look for cranial mass
76
How is precocious puberty managed
GnRH analogue
77
Define delayed puberty
- Puberty after 14 in girls in absence of secondary sexual characteristics - Puberty after 16 in presence of secondary sexual characteristics
78
What are 5 causes of delayed puberty
1. Constitutional delay 2. Systemic disease (eg. CF) 3. Malnutrition 4. HPA disorders 5 Ovarian failure
79
What is constitutional growth delay
Delay in puberty or growth that is not due to underlying pathological cause
80
What investigations are ordered for constitutional delay
Oestrogen, Progesterone LH, FSH Prolactin X-ray
81
If prolactin is over 1500 what should be ordered
TFT, U+E - Exclude hypothyroidism and renal failure that can mimmic prolactinoma Cranial MRI - look for tumour
82
Why is an x-ray ordered
Look for bone maturation and epiphyseal plate closure
83
How will mccune ablright syndrome present
Precocious puberty Cafe au lai spots Short stature Polyostotic fibrous dysplasia

Gynaecology (22 decks)

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