Case 2 - puberty Flashcards
what is puberty?
process of physical changes through which a child’s body matures into an adult body capable of sexual reproduction
how does puberty begin?
- KiSS kisspeptins stimulate GnRH secretion
- activation of HPG axis initiates puberty
- release of LH and FSH regulate sex steroids production for pubertal development and reproductive capability
when do boys and girls start puberty?what are the indications/
girls 8-14 - breast budding, growth spurt, pubic hair = menarche (periods) at end of puberty
boys 9-15 years - testicular enlargement, pubic hair - growth spurt mid-puberty
How is puberty rated?
tanner stages of puberty 1- pre-pubertal to 5-mature
Females: B- breast development
Males: G - genital development/ testicular growth
Both: P - pubic hair/ A - axillary development (armpit hair)
how is abnormal growth identified?
growth charts - age/ height
- if measurements veer away centile lines and fall significantly outside target centile range
what is height velocity? how does this differ between boys & girls?
height velocity - growth in relation to age - occurs once puberty has started
- girls: 8 cm/year
- boys: 10 cm/year
how is bone age determined?
looking at x-ray of non-dominant hand & wrist - more ossification centres - can confirm delayed/ advanced skeletal maturation during puberty
what are the key indications of delayed puberty?
- small stature
- low height velocity
- delayed skeletal maturation
- no evidence of sex steroid production
what is hypogonadotrophic hypogonadism?
delayed puberty due to a defect in HPG axis - low serum gonadotrophs
- hypopituitarism - tumour
- hypothyroidism
- chronic illness
what is hypergonadotrophic hypogonadism?
delayed puberty associated with primary gonadal failure/ structural abnormalities in HPG axis -high serum gonadotrophs
- gonadal dysgenesis/ damage to testes & ovaries
what treatments can be used for delayed puberty?
dependent on course
- sex steroids -accelerate growth (boost self-esteem)
- testosterone injections
- oestrogen patch
what is precocious puberty?
appearance of physical & hormonal signs of pubertal development at an earlier age (boys before 9/ girls before 8)
- tall stature
- rapid growth rate
- advanced skeletal maturation
- sex-steroid production
what is the difference between dependent and independent precocious puberty?
dependent - early activation of HPG axis due to head injury/ tumours
independent - development of sex steroids without activation of HPG axis- adrenal/ gonad tumours
how can precocious puberty be treated?
switch off gonadotrophins - efficient if done before 8 years of age
