3. Puberty-related conditions

Question 1

what is precocious puberty

Answer 1

physical signs of sexual maturation before 8 yrs (girls) or 9 yrs (boys), or menarche before 10 yrs

Question 2

suggest possible causes of precocious puberty

Answer 2

1. simple variation of normal dev.
2. problems with hypothalamus causing increased GnRH secretion (e.g. irritation due to meningitis or TB, hypothalamus tumour) - central precocious puberty
3. increased Oe or T secretion, e.g. due to ovarian cysts/tumours or functional testicular cancer - peripheral precocious puberty

Question 3

name a possible complication of precocious puberty

Answer 3

short adult stature due to rapid bone maturation and early closure of epithelial growth plates

Question 4

what is delayed puberty

Answer 4

males: absence of testicular dev. (or testicular volume <4ml) by 14 yrs
females: absence of breast dev. by 13 yrs or normal breast dev. but primary amenorrhea by 15 yrs

Question 5

suggest possible causes of delayed puberty

Answer 5

1. simple constitutional delay
2. normal plasma LH/FSH: gonadal dysgenesis (e.g. Klinefelter’s syndrome, Turner syndrome, PCOS), bilateral testicular damage (e.g. testicular torsion)
3. low plasma LH/FSH: malnutrition (e.g. anorexia nervosa, coeliac disease), hypothalamic and pituitary tumours, Kallman’s syndrome, high androgens…