Abnormal Puberty Flashcards
define delayed puberty
- female not getting menarche by 16Y or within 5Y of starting puberty
- female no breast development (thelarche) by 13Y
- male not starting testicular enlargement by 14Y
define precocious puberty
- female getting secondary sex characteristics less than 8Y
- female getting menarche less than 9
- male having secondary sex characteristics before 9Y
is pathogenic causes of delayed puberty more common in males or females
females
is pathogenic causes of precocious puberty more common in males or females
males
name 5 common causes for delayed puberty
hypergonadotropic hypogonadism (GnRH-independent)
1. malnutrition - celiac, eating disorder
2. genetics - tuner or Klinefelter
3. primary gonadal failure
4. gonadal damage/trauma
hypogonadotropic hypogonadism (GnRH-dependant)
1. inactivation of HPG axis
2. constitutional delay in activation
name 5 common causes for precocious puberty
hypergonadotropic hypergonadism (GnRH-dependant)
1. premature activation of HPG axis
2. brain tumour
hypogonadotropic hypergonadism (GnRH-independant)
1. iatrogenic - steroid creams etc.
2. obesity - excess estrogen
3. primary hypothyroidism - TSH looks like FSH
4. adrenal pathologies (androgens for secondary characteristics)
5. FSH and LH secreting tumours
s/s of delayed puberty
Female
- No signs of breast development by 13Y
- Absence of menarche by 15Y
Male
- No testicular enlargement by 14Y
Suspect if there is a halting or regression of pubertal development
s/s of precocious puberty
Female
- early development of breast development
- early period
male
- all pubertal boys <9Y should be fully evaluated
what’s the approach for abnormalities of puberty?
- good family history and diet history
- tanner stages
- growth velocity w/ projected height vs actual height
- hormones: FSH, LH, testerone, estrogen, DHEA, 7-OHP
- bone age scan
- DHEA and 7-OHP - if showing hyperandrogenic s/s
- imaging - pelvic u/s or MRI of head for s/s
precocious
1. consider GnRH analogue stimulation test for central causes (when LH > 0.3)
2. TSH
delayed
1. thyroid function - TSH
2. prolactin
3. IGF-1 ➔ growth hormone
Others
- karyotyping
- GI/malnutrition
tx for delayed puberty
- refer to ped endocrinologist
- consider jump-starting puberty w/hormone therapy
- estradiol and progesterone to females
- testosterone to males
tx for precocious puberty
- refer to ped endocrinology
- GnRH agonist to stop hormone production ➔ want to stop growth to stop premature closure of growth plates
if peripheral causes, tx etiology
how does the GnRH stimulation test work?
used to confirm a central cause of precocious puberty
- bloodwork before w/ FSH and LH
- injection of GnRH analogue to mimic a pulsitile release of GnRH
- w/an activated HPG axis, there will be an increase FSH and LH blood level in post injection bloodwork
if there was a peripheral cause, there would be no change in FSH/LH or a slight decrease in FSH/LH levels as it’s a hypergonadism issue vs a hypergonadotropic problem
