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Paediatrics 2 > Delayed Puberty > Flashcards

Delayed Puberty Flashcards

1
Q

Between what ages does puberty normally start in girls?

A

8-14

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2
Q

Between what ages does puberty normally start in boys?

A

9-15

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3
Q

How long does puberty last?

A

About 4 years

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4
Q

How does puberty start in girls?

A

The development of breast buds, then pubic hair

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5
Q

When does menstruation start in girls?

A

2 years into the start of puberty

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6
Q

How does puberty start in boys?

A
  • enlargement of the testicles, then of the penis
  • Gradual darkening of the scrotum
  • Development of pubic hair
  • Deepening of the voice.
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7
Q

What is Tanner staging used for?

A

To determine the pubertal stage based on examination findings of sex characteristics.

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8
Q

What is Hypogonadism?

A

A lack of the sex hormones, oestrogen and testosterone, that normally rise prior to and during puberty.

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9
Q

What do a lack of oestrogen and testosterone lead to?

A

A delay in puberty

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10
Q

What can a lack of oestrogen and testosterone be due to?

A
  • Hypogonadotrophic hypogonadism

* Hypergonadotrophic hypogonadism

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11
Q

What is Hypogonadotrophic hypogonadism?

A

A deficiency of LH and FSH

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12
Q

What is Hypergonadotrophic hypogonadism?

A

A lack of response to LH and FSH by the gonads

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13
Q

What does a deficiency of LH and FSH lead to?

A

A deficiency of the sex hormones testosterone and oestrogen.

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14
Q

What is a deficiency of FSH and LH the result of?

A

Abnormal functioning of the hypothalamus or pituitary gland.

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15
Q

What can abnormal functioning of the hypothalamus or pituitary gland be due to?

A

Previous damage to the hypothalamus or pituitary
Growth hormone deficiency
Hypothyroidism
Hyperprolactinaemia (high prolactin)
Chronic conditions can temporarily delay puberty
Excessive exercise or dieting
Kallman syndrome

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16
Q

What could have caused previous damage to the hypothalamus or pituitary?

A

Radiotherapy or surgery for previous cancer

17
Q

Which chronic conditions can cause a temporary delay in the onset of puberty?

A

Cystic fibrosis

Inflammatory bowel disease

18
Q

What is Kallmann’s syndrome a cause of?

A

A cause of delayed puberty secondary to hypogonadotropic hypogonadism

19
Q

What type of inheritance does Kallmann’s syndrome have?

A

X-linked recessive

20
Q

What is the typical presentation of someone with Kallmann’s syndrome?

A

A boy with delayed puberty and a lack of smell (anosmia)

21
Q

What is Hypergonadotropic hypogonadism?

A

This is where the gonads fail to respond to stimulation from the gonadotrophins (LH and FSH).

22
Q

Why are there high levels of FSH and LH in someone with Hypergonadotropic Hypogonadism?

A

The anterior pituitary produces increasing amounts to try harder to stimulate the gonads.

23
Q

What would you find in someone with Hypergonadotropic Hypogonadism?

A 
High gonadotrophins (“hypergonadotrophic”) 
Low sex hormones (“hypogonadism”).
24
Q

What are possible causes of Hypergonadotropic Hypogonadism?

A
  • Previous damage to the gonads
  • Congenital absence of the testes or ovaries
  • Kleinfelter’s Syndrome (XXY)
  • Turner’s Syndrome (XO)
25
Q

What are possible genetic causes of Hypergonadotropic Hypogonadism?

A
  • Kleinfelter’s Syndrome (XXY)

* Turner’s Syndrome (XO)

26
Q

What previous damage to the gonads could result in Hypergonadotropic hypogonadism?

A

Testicular torsion
Cancer
Infections-mumps

27
Q

What is the threshold for initiating investigating someone for pubertal delay?

A

When there is no evidence of pubertal changes in a girl aged 13 or a boy aged 14.

28
Q

What is the first step in investigating someone with pubertal delay?

A

Take a detailed history of their general health, development, family history, diet and lifestyle.

29
Q

What results would you get from early morning serum FSH and LH (the gonadotropins)?

A

low in hypogonadotrophic hypogonadism

high in hypergonadotrophic hypogonadism

30
Q

When would you carry out investigations for pubertal delay?

A

When there is some evidence of puberty but no progression over 2 years.

31
Q

Why might you do an x-ray in someone with pubertal delay?

A

An x-ray of the wrist to assess bone age and inform a diagnosis of constitutional delay

32
Q

Why might you do a pelvic ultrasound in someone presenting with pubertal delay?

A

Pelvic ultrasound in girls to assess the ovaries and other pelvic organs

33
Q

Why might you do an MRI in someone presenting with pubertal delay?

A

To look for pituitary pathology and assess the olfactory bulbs in possible Kallman syndrome

34
Q

What is the management in the majority of cases of pubertal delay?

A

Reassurance and observation

35
Q

What medical management can be given for pubertal delay?

A

Replacement sex hormones (oestrogen in girls and testosterone in boys) can be used to induce puberty under expert guidance.

Paediatrics 2 (47 decks)

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