Disorders of Puberty Flashcards
Puberty is the period when ___ develop and capability of ___ is attained
onset at __yrs (__ yrs in AA)
Thelarche/pubarche has peak ___ and ____
occurs over ___yrs in girls
___ inc allows for growth of ___ tissues such as b__, v___ and u
sec sex char, sex repro
8-13, 7-13
ht velocity, menses
4.5
estrogen, estrogen sens, breasts/vulvovaginal tissue, uterus
1/2 of ___ is laid down in puberty, allowing for
mediated by
90% total body mineral content by ___
adolescents req __ of Ca daily, ___ of VD and __ exercise
Body fat inc after ___ in girls
deposition occurs on
ones who mature early at inc risk for
menarche prior to _ assc w inc bodyweight
total body Ca, bone growth
estrogen/GH
17
1200-1300mg, 400 IU, weight bearing
peak height velo
back/arms/thighs
obesity
12yo, bodyweight
Puberty has higher rates of __ in girls, __ at greatest risk
Inc risk of ___ in those maturing earlier
__ is not mature
Pubertal skin changes- inc ___ results in acne
could also indicate other conditions, such as
depression, Caucasian
behavioral disorders
prefrontal cortex
androgenic activity
PCOS, Non-classic CAH
Breast development
Stage 1
Stage 2- breast bud stage w ___, enlarged ___
Stage 3- enlarged __, no __
Stage 4 __ and ___ form a secondary mound above breast
Stage 5– _ stage
projection of __, related to recession of
prepubertal
elevation of breast/papilla, areola
breast/areola, separation
areola/papilla
mature
papilla, areola
Pubic hair
Stage 1 is ___ may have __ hair, similar to forearms
Stage 2- sparse growth of ___, can be curled at
Stage 3 becomes ___, spreads of jxn of
Stage 4- __ in type, covers smaller area, does not spread to
Stage 5- __ in type, with __ border
prepubertal, vellus
long, slight pigmented, base of penis/labia
darker, coarser, curled, pubes
hair adult, medial surface of thighs
adult, horizontal upper border
Precocious puberty is the manifestation of __ prior to age
Sub categories- __ dep PP (central)
____ indep PP (peripheral)
benign or ___ pubertal variants (incomplete PP)
sec sex charact, 8 in females
gonadotropin
Gonadotropin
non-progressive
GDPP (central)
Premature maturation/development of \
Seq is same as puberty but
Typically
Gonadotropin/E2 levels are
Bone age is ___, ___ growth
Other etiology: ___ of CNS, r____, h___, h___, c___, g___, previous
HPG axis
early
idiopathic
inc
advanced, linear
tumor/infect, radiation, hydrocephalus, head trauma, cerebral edema, gene mutations, high dose steroid exposure
GDPP labs- if ___ inc, it is consistent
GnRH agonist will make it
GIPP has excess
___ source
can be ___/__sexual
Gonadotropin levels are
With GnRH agonists, there is
gonadotropins
inc even more
estrogen, androgens
adrenal/ovarian/exogenous
iso/contra (virilization)
low (prepubertal)
no inc gonadotropins
GIPP etiology fxn ___, o___ such as granulosa cell tumors/gonadoblastomas, C__, a____, M___, Primary __ as TSH crossrx w ovarian ___ receptors
McCune Albright Syndrome
mutation in __ of G3 protein activating
manifests as
more common in
ovarian cyst, ovarian neoplasm, CAH, Mccune Albright syndrome, HypoT (FSH)
alpha subunit, AC
PP, cafe au lait, fibrous dysplasia
girls
Benign/NP IPP
can be broken into premature
Isolated __ dev <8 and no additional
must be monitored for progression to true __ every 3-6mnths
Despite breast develop in premature thelarche, estradiol level is
premature adrenarche, a total __, D___ and ___ should be eval along w
more common in pt w
inc risk of ___
if overweight, counsel on
measure bone age on
adrenarche/thelarche
breast/pubic hair, sec sex charact
PP
prepubertal
testo, DHEAS, 17OHP, bone age
darker skin
PCOS
exercise/diet changes
non dominant wrist
Premature thelarche is
Premature adrenarche is
Tx of GDPP
this prevents
also slows ___ and prevents
Right adnexal mass, look for ___ as a tumor marker for ___ tumors
if tumor level elevated, refer to Gyn/Onc and Peds Surg for
isolated breast devel wo other SSC
isolated pubic/axillary hair devel wo other SSC
GnRH agonist
premature closure of epiphyseal plates
skeletal maturation, progression of SSC
inhibin, granulosa cell
oophorectomy, tumor staging
If right adnexal mass is benign appearing cyst and simple, it is a
monitor for signs of
sx will resolve
Delayed puberty is the absence/incomplete devel of ___ bounded by age at which ___ of children of that sex/culture have ___ sex maturation
ie absence of breast devel in girls at an age > than ___ than pop mean, usually above 13
folllicular cyst
ovarian torsion
spontaneously
SSC, initiated
2-2.5yrs
Hypergonadotrophic Hypogonadism
Inc __ >30
Indicates ___
Gonadotropin inc secondary to dec hormones from
Ddx includes P___ T___, C___. S____
FSH
Ovarian failure
gonad
Premature Ovarian Failure, Turner Syndrome, Complete Gonadal Dysgenesis, Swyer Syndrome
Premature ovarian failure/insufficiency
Amenorrhea prior to
Elevated __ and low___
Secondary to accelerated atresia of ____
Assc w ___ and __
Pts may have G___, T___, s____
Further workup includes K____, t____, a___
Tx w
Baseline __ to eval bone health
40 yo
FSH, estradiol
ovarian follicles
Turner syndrome and Pure gonadal dysgenesis
Galactosemia, Trisomy 21, sarcoid
karyotype analysis, thyroid studies, adrenal gland
estrogen/progestin
DEXA
Turner Syndrome
45 ___ or 45 __, ___ or 45 ___, ___
B S W S L H M G M P L L
45X or 45, X/46 or 45, X/46, XY
Broad chest short stature webbed neck short 4th metacarpal low hairline High palate Micrognathia Genu valgum Multiple pigmented nevi Ptsosis Low ears Lymphedema
Turner syndrome at risk for C- bicuspid aortic valve, ARD, MVP R- such as H/D O S
Pts have ___ intell
Defects in ___ processing and ___ coordination
Can become preg w ___ but risk of ___ inc
cardiac abnorm renal abnorm- horshoe kidney HTN, DM Osteopenia Streak gonads
normal
spatiotemporal, visual motor
Donor eggs, aortic rupture
If TS is suspected, get
K
If Y chromo is present, gonads must be removed to dec risk of
Treat w
After several yrs, pt bw 12-15 needs
Goal of therapy is
Add ___ after first bleeding episode or after 1yr of
Karyotype
germ cell tumor
GH
exogenous estrogen therapy
breast/bone dev, menses, linear growth
progestin
Pure Gonadal Dysgenesis
46__ or 46___ phenotypic females w
Inheritance
Elevated ___ bc streak gonads do not
___ to __ stature
46XY known as
W Y chromo, ___
No ___ so uterus is
46XX or 46XY streak gonads
Xlinked, AR
FSH, produce hormones
normal/tall
Swyer syndrome
remove gonads
AMH, present
Previous radiation/Chemotherapy needs ___ prior to tx
Subsequent depot ___ to attempt ___, alternative is
Worse outcomes w alkylating agents and
FSH/E2
lupron, ovarian preservation, oophoropexy
older age
Hypogonadotropic Hypogonadism
Dec
Gonads producing low hormone as response to
Reversible causes- c__, a__, primary ____, C___, P____, F____
irreversible causes: K____, H____, CNS lesion, c___
FSH
low stimulation
constit, anorexia, hypoT, CAH, prolactinoma, Female Athlete Triad
Kallman Syndrome, Hypopotuitarism, chronic dz
Anorexia is more than ___ below ideal body wt
Can ___ or __ puberty
Can develop (3)
GI sx such as __, ___ changes, blue ___, hair ___
PE: oral ___, ___ appearance, ___ swelling
Image for ___ > 1yr
TX decide bw
get to ___ of IBW
consider
Complication
15%
delay/interrupt
DI, hypoT, inc cortisol
bloating, early satiety, const, hands/feet, loss
erosions, scaphoid, parotid gland
bone density
hospital/outpt psych
90-92%
prozac
inc mortality rate
Anorexia DSM 5
(a)Restricted ___ relative req, leading to signif low ___ (less than minimally normal)
in context of
(b) Intense fear of ___. or becoming ___, or behavior that prevents
(C) disturbance in way of which ones BW/shape is ____, w self eval or lack of
Restrcting type: last 3m, individual has not engaged in recurrent episodes of _____/____
wl is accomplished by ___
energy intake, BW
age, sex, devel, physical health
gaining weight, fat, wg
experienced, recog
binge eating, purging
diet/exercise/fasting
Binge eating/purging tye: indiv has engaged in
In partial remission- met criteria for ___, but ___ has not been met, but __ or __ is met
In full remission: after criteria for __ met, ___ others have been met
Mild BMI >
Mod bw
Severe BMI bw
Extreme BMI
these behaviors
AN, criteria A, Criteria B/C
AN, no
17
16-16.9
15-15.9
15
Kallman Syndrome aka
Failure of GnRH neuron to migrate from ___ to
Assc w
No __ or
May have ___
Inheritance
Eugonadism- Normal __ and anatomic ____
assc w M____, T___, I ___, A____
Congenital GnRH defic
olfactory placode, hypothalamus
Anosmia/hypogonad
Breast/oubic hair
cleft lip/palate
Xlinked/AD
FSH, defect
Mullerian agenesis, Transverse vaginal septum, imperforate hymen, androgen insens
