Conference: Adolescence and Puberty Flashcards

1
Q

What secretes the following: 1. GnRh 2. Gonadotropins

A
  1. Hypothalamus 2. Anterior Pituitary
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2
Q

What is the function of FSH? (males and females for both) What is the function of LH?

A

FSH: Females - stimulates granulosa Male - stimulate Sertoli cells LH: Females - stimulates THECA Males - stimulates Leydig cells to secrete androgens

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3
Q

What has no role in development of the female GU tract? When does oogenesis occur? What forms at this time?

A
  1. Ovaries 2. Occurs between 15-28 weeks of gestation and developing FOLLICLES enter a prolonged prophase (10-45 years)
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4
Q

What are the ‘nurse’ cells in that testis? Leydig Cells disappear and reappear when? What do they produce?

A
  1. Sertoli cells - MIF –> regression of mullein duct - H-Y - Inhibin - Tight Junctions 2. Leydig cells disappear after birth and reappear before puberty - form TESTOSTERONE
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5
Q

Testosterone: 1. Has direct actions on ____ and ____ tissue 2. Stimulates differentiation of ______ into epidydimus, vas deferent, and seminal vesicles 3. In puberty, T with or without DHT causes what? 4. T is converted into what 2 things?

A
  1. Fetal & adult 2. Wollfian Duct 3. secondary sexual characteristics and pubertal growth spurt (testosterone) 4. T converted to DHT and 5-alpha-androstanediol
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6
Q

_____ is required in the fetus for differentiation of the genital tubercle into the genital swellings, folds, UG sinus into the penis scrotum, and prostate respectively.

A

DHT!!!

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7
Q

______ differentiates into the following: fallopian tubes, uterus, cervix, and upper vagina _____ into seminiferous tubules, rate testes, ductus efferents, epididymus, vas deferens, ejaculatory duct, seminal vesicles, prostate gland, bulbourethral glands.

A
  1. Mullerian Duct 2. Wolfian Duct
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8
Q

What is the term for the transition from non-reproductive to reproductive status? What does it require?

A

PUBERTY Requires intact hypothalamus, pituitary, and gonadal development and communication.

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9
Q

Pre- Puberty: What explains the low levels of BOTH FSH and LH AND GnRh? What does gradual onset of maturation on hypothalamus lead to increased synthesis of? As puberty approaches, pulsatile release of ____ and ____ occur

A
  1. Either negative feedback system is inoperative OR the pituitary and hypothalamus are insensitive to testosterone, INHIBIN, and ESTRADIOL 2. Increased synthesis and release of GnRH!! 3. FSH and LH
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10
Q

Onset of Puberty: Timing ranges from _____ What does timing of development depend on? Who starts puberty 2 years earlier, girls or boys? When do girls start puberty?

A
  1. 9-17 years old 2. genetics, race, and nutritional status 3. Girls start puberty 2 years BEFORE BOYS 4. 8-10 years
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11
Q

Female: 1. Pituitary hormone secretion stimulates ____ and ____ glands 2. Breast budding ______ and pubic hair _____ first appear 3. Development of what coincides with the first detectable increase in plasma Estradial (E2)? 4. Menarche (first menses) usually occurs between what ages? 5. No menarche 2.5 years after _____ is considered abnormal.

A
  1. Ovaries and Adrenal glands 2. THELARCE = breast budding ADRENARCHE = pubic hair 3. THELARCE considers with plasma E2 - no thelarche by age 13 is considered “delayed” 4. 11- 14 years old (changed from 14.5 years in 1900 to 12.5 years in 1990) 5. THELARCHE
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12
Q

Menarche is delayed in what type of patients? (2) Accelerated in? (2)

A
  1. Undernourshed patients 2. Frequent strenous exercise 1. Obesity 2. Blindness
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13
Q

Male onset of puberty at _____ years. Complete sexual functioning by _____ years. What is normal variability? Pituitary hormone secretion stimulates ___ and ____ The first and most important sign is what? (due to increased FSH production) This correlates with increased volume of _______

A
  1. 10-11 years 2. 15-17 years Normal variability: onset early as 8 years, and completion as late as 20 3. Pituitary hormone stimules TESTES and ADRENAL glands 4. Enlargement of the testes (increased FSH) - increased volume of seminiferous tubules
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14
Q

Males - Puberty: What 3 things are needed to stimulate testosterone synthesis? Once this has initiated, what can occur?

A
  1. FSH 2. LH 3. leydig cells Primary and Secondary sex characteristics can occur
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15
Q

When does spermatogenesis begin? Although erections can occur from birth, the ability to ejaculate semen does not occur until ______ What else occurs?

A

13 years 12-15 years Scrotal skin darkening, larynx enlargement, testes enlargement, penis enlargement, body hair, and facial hair appears

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16
Q

What hormone has an effect on epiphyseal closure?

A

Estradiol (E2) - girls start their growth spurt 2 years before boys

17
Q

Tanner Stages: Female BREASTS (describe the following) Stage 1,2,3,4,5

A

Stage 1: appearance typical of children 2: breast button stage; areola increases in diameter and pigmentation; breast and nipple are elevated 3: More growth, similar in appearance to adult except smaller 4: areola around nipple continue to grow, nipple forms a secondary young 5: adult appearance, areola not separated from the plane of the rest of the breast tissue

18
Q

Tanner Stages: Female PUBIC HAIR (describe the following) Stage 1,2,3,4,5

A

1: appearance typical of children 2: Scant, find smooth, light colored hair on labia major 3: increased in quantity, spread to pubis 4: similar quality, tension limited to pubis 5: adult distribution (triangular form)

19
Q

Tanner Stages: Male Male Sex Organs (describe the following) Stage 1,2,3,4,5

A

1: typical of children 2: increase of about 3mm in volume, increased size of scrotum, pigmentation of scrotal skin 3: increased length of penis small increase in diameter; increased size of scrotum 4:Increased in length and diameter of the penis; development of glans penis; further pigmentation and growth of scrotum 5; adult

20
Q

Tanner Stages: Male Pubic Hair (describe the following) Stage 1,2,3,4,5

A
  1. Typical of children 2. Scant, long, light colored, slightly curly at base of penis and scrotum 3. Curly, coarse, darker, increase quantity extending to pubis 4. Abundant, adult characteristics, still limited to pubis 5. Adult, rhomboidal distribution
21
Q

Menstrual Cycle: The following describes which stage: Follicular, Ovulation, Luteal: 1. Corpus luteum makes progesterone and E2. 2. Progesterone (pro-gestational) prepares the uterus for implantation of egg. 3. Decreased endometrial thickening. 4. Spiral artery differentiation.

A

Luteal

22
Q

The following describes which stage: Follicular, Ovulation, Luteal: 1. As E2 increases, POSITIVE feedback to the hypothalamus and pituitary cause LH surge, and follicle is released.

A

Ovulation

23
Q

Menstrual Cycle:

The following describes which stage: Follicular, Ovulation, Luteal:

  1. Pulsatile GnRH release from hypothalamus.
  2. Increased FSH & LH from pituitary.
  3. Ovarian follicle growth.
  4. Ovarian Estrogen (E2) production.
  5. Endometrial thickening
A

Follicular phase

24
Q

What do the following abnormal menstrual cycles mean?

  1. Menorrhagia
  2. Metrorrhagia
  3. Polymenorrhea
  4. Oligomenorrhea
A
  1. Menorrhagia - normal interveal, increased flow
  2. Metrorrhagia - irregular interval, increased flow
  3. Polymenorrhea - intervals between menses <21 days
  4. Oligomenorrhea - intervals between menses > 35 days
25
Q

Menarchie occurs when?

Cycle every how many days?

How long do they last?

How much blood loss?

A
  1. 12.7 years
  2. 21-35 days
  3. last 3 - 7 days
  4. experience 30-40 cc blood loss with each menstruation
26
Q

What happens without fertilization? (4)

A
  1. Implantation does not occur
  2. No hCG is made.
  3. Luteum regresses.
  4. Progesterone & E2 decrease.

****Menses.

27
Q

Most adolescents have a ____ feedback of E2 on HPO axis.

Increased E2 at mid-cycle causes decreased (2)_____.

No _____ occurs.

Decreased ____ levels.

Withdrawal bleeding occurs.

A

. NEGATIVE

  1. DECREASED LH & FSH.
  2. ovulation
  3. E2
28
Q

Menstruation without Ovulation example 2:

No _____ decrease (no negative feedback).

Unopposed ____ stimulation of endometrium outgrows blood supply and is sloughed.

Result?

A
  1. E2
  2. E2

Metrorrhagia –> irregular intervals, increased flow

29
Q

TEST:

What is the timing for development in females?

When does menarche first occur?

No pubertal devlopment by which age warrants investigation?

What develops first in girls? In boys

A
  • Timing of development. (e.g. thelarche before menarche)
  • Menarche (first menses) usually occurs between 11-14 y/o (average in U.S. 12.5 years).
  • No pubertal development by age 13 warrants investigation.

Girls – breast bud development first

Boys – testicular development

30
Q

What difference between Tanner stages is abnormal?

First signs of pubertal development in males(size) and females?

Puberty is precious if less than ____ old in females and ____ old in males

A

•A > two Tanner stage difference is abnormal.
•First signs of pubertal development:
–male: increase in testicular volume.(>3)
–female: breast buds.
•Puberty is considered ‘precocious’ if:
–< 6 y/o in females
–< 9 y/o in males

31
Q

Normal menstrual cycles in a female depends on NEGATIVE feedback between E2 and FSH and LH.

True or False?

A

False

Normal cycles depend upon POSITIVE feedback

  • corpus luteum stimulates ESTROGEN to secrete more FSH and LH
32
Q

Curpus luteum makes progesterone and E2

WHat is the effect of progesterone?

Which stage is there a positive feedback of E2 on LH?

Negative?

A
  1. Progesterone causes the uterine lining to stop proliferating and causes spiral atery differentiation in preparation for egg deposition
    - also has a NEGATIVE effect on FSH and LH release, which in turn decreases E2
  2. OVULATON: E2 increases, positive feedback on hypothalamus and pituitary causes LH surge and a follicle is release
  3. LUTEAL: progesterone negatively inhibits FSH and LH and decreases E2 levels