Conference: Adolescence and Puberty

Question 1

What secretes the following: 1. GnRh 2. Gonadotropins

Answer 1

1. Hypothalamus 2. Anterior Pituitary

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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?

Answer 5

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

Question 6

_____ 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.

Answer 6

DHT!!!

Question 7

______ 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.

Answer 7

1. Mullerian Duct 2. Wolfian Duct

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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?

Answer 10

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

Question 11

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.

Answer 11

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

Question 12

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

Answer 12

1. Undernourshed patients 2. Frequent strenous exercise 1. Obesity 2. Blindness

Question 13

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 _______

Answer 13

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

Question 14

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

Answer 14

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

Question 15

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

Answer 15

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

Question 16

What hormone has an effect on epiphyseal closure?

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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)

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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.

Answer 21

Luteal

Question 22

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.

Answer 22

Ovulation

Question 23

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

Answer 23

Follicular phase

Question 24

What do the following abnormal menstrual cycles mean?

1. Menorrhagia
2. Metrorrhagia
3. Polymenorrhea
4. Oligomenorrhea

Answer 24

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

Question 25

Menarchie occurs when?

Cycle every how many days?

How long do they last?

How much blood loss?

Answer 25

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

Question 26

What happens without fertilization? (4)

Answer 26

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

****Menses.

Question 27

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.

Answer 27

. NEGATIVE

2. DECREASED LH & FSH.
3. ovulation
4. E2

Question 28

Menstruation without Ovulation example 2:

No _____ decrease (no negative feedback).

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

Result?

Answer 28

1. E2
2. E2

Metrorrhagia –> irregular intervals, increased flow

Question 29

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

Answer 29

• 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

Question 30

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

Answer 30

•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

Question 31

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

True or False?

Answer 31

False

Normal cycles depend upon POSITIVE feedback

• corpus luteum stimulates ESTROGEN to secrete more FSH and LH

Question 32

Curpus luteum makes progesterone and E2

WHat is the effect of progesterone?

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

Negative?

Answer 32

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