37) Pediatric and Adolescent Gynecology

Question 1

Describe the Endocrinology behind Pediatric / Adolescent Gynecology?

Answer 1

• At birth, FSH / LH RISE ABRUPTLY - to compensate for DECREASED Placental Oestrogen
• Gradual INCLINE of FSH / LH within first few months of life
• Childhood Years are characterised with LOW plasma levels of FSH / LH / Estradiol

Question 2

What is the definition of “Puberty?

Answer 2

• Well-defined sequence of physical + physiological changes during adolescence
• Attaining full sexual + physical maturity

ONSET of Puberty = 8 - 13 Years Old

PRECOCIOUS Puberty = Changes BEFORE Puberty

DELAYED Puberty = Changes AFTER Puberty

Question 3

What are the Pubertal Changes?

Answer 3

1) Adenarche - activation of adrenal androgen production (8 years old)

2) Gonadarche - reproductive glands activation via LH / FSH (9 - 10 years old)

3) Thenarche - Breast Development (8 - 11 years old)

4) Pubarche - Pubic Hair Growth (12 years old)

5) Menarche - Menstrual Bleeding (10 - 16 years old)

Question 4

What are the Types of Precocious (early) Puberty?

Answer 4

1) Central Precocious

2) Peripheral Precocious

3) Heterosexual Precocious

Question 5

What is CENTRAL PRECOCIOUS Puberty?

Answer 5

• It’s Gonadotropin-dependent
• From early activation of hypothalamic-pituitary-ovarian axis causing increased gonadotropin release
• Usually idiopathic - otherwise can be due to Neurofibroma, Hydrocephalus, Trauma, Infection, Astrocytoma

Question 6

What is PERIPHERAL PRECOCIOUS Puberty?

Answer 6

• It’s Gonadotropin-independent
• Presented with HIGH Levels of Oestrogen only

Due to Sex Steroids secretion from Ovaries, such as:

• hormone-producing ovarian / adrenal tumors
• Ectopic Gonadotropin Production
• Primary Hypothyroidism

Question 7

How can Precocious Puberty be Diagnosed and Managed?

Answer 7

DIAGNOSIS

• Gonadotropin Levels
• Thyroid Function Tests
• FSH, LH, Estradiol Levels
• GnRH Stimulation - Increased LH means Central-P ; Decreased means Peripheral-P

MANAGEMENT

• Slowing down accelerated growth
• Reducing Pituitary, Ovarian + Adrenal Fx
• Gonadotropin-RH agonists

Question 8

What is Delayed Puberty?

Answer 8

ABSENCE OF:

• Breast Development by Age 13
• Menses by Age 16

DUE TO :

• anatomical abnormalities
• Hyper / Hypo-gonadotropic Hypogonadism

Question 9

What is Hyper / Hypo-gonadotropic Hypogonadism?

Answer 9

HYPER-Gonadotropic Hypogonadism

• Issues with actual gonads themselves, despite increased levels of LH / FSH, which are trying to stimulate the gonads
• Turners, Kleinfelter’s Syndrome

HYPO-Gonadotropic Hypogonadism

• Issues with Hypothalamus, or PG - resulting in low levels of LH / FSH
• Kallman’s Syndrome
• Tumors, Trauma, Anorexia

Question 10

What are the Most Common Abnormalities in Pediatric Gynecology?

Answer 10

• Trauma, Infections (Vulvitis - itching )
• Tumors (Ovarian)
• Dysfunctional Uterine Bleeding - presented with Menometrorrhagia (heavy, irregular bleeding)
• Amenorrhea - NO menstrual flow by 16 years old ; Due to Kallman Syndrome, Anorexia, Athlete, Turners Syndrome, PCOS, Cushing’s Syndrome
• Labial Adhesion - where labial minora’s fused with thin line of demarcation