Early and Delayed Puberty Flashcards
years of puberty for boys and girls
girls: 10-14
boys: 12-16
3 peaks of hpg
fetal midgestation
postnatal first 1-6 mos
puberty
hpg status in early childhood to pre-pubertal
dormant, undetectable serum lh and sex hormones
hpg secretion in peripuberty
low in the daytime, increases in amplitude and frequency during sleep
hpg secretion mid-puberty
lh pulses become evident even duing daytime and occur about 90-120 min intervals
hormone sequence in hpt axis
gnrh -> fsh and lh
fsh -> sertoli cells inhibin b
lh -> leydig cells -> testosterone -> estradiol
effects of estradiol
breast development (gynecomastia for males), growth acceleration, skeletal (bone) maturation
role of adrenals in puberty
produce dhea and dhea-s (marker for adrenal androgen secretion)
incerases at 6-8 yo
first changes in females
breast budding (some pubic and axillary hair)
first changes in males
testicular enlargement
breast development stages
1 - prepubertal with no palpable breast tissue
2 - breast bud, elevation of papilla and enlargement of areolar diameter
3 - enlargement without separation of areolar contour
4 - areola and papilla project, forms secondary mound
5 - recession of areola to match contour of breast, papilla projects beyond contour of breast
pubic hair development stages (female)
1 - prepubertal with no pubic hair
2 - sparse, straight hair along lateral vulva, pigmented
3 - darker, coarser, curlier, extends over mid-pubis
4 - adult like but doesnt extend over thighs
5 - adult, from thigh to thigh
external genitalia development (males)
1 - prepubertal
2 - testes and scrotum enlarge, scrotal skin reddens and changes texture
3 - enlargement of penis (length at first)
4 - increased size of penis, development of glans, testes and scrotum become larger, scrotal skin darker
5 - adult
pubic hair development (male)
1 - prepubertal
2 - sparse, straight pubic hair along base of penis
3 - darker, coarser, curlier extending over mid-pubis
4 - adult-like, but not extending to thighs
5 - adult, thigh to thigh
size of beads for comparison for testicular vol
prepubertal: 1-3 ml
pubertal: 4-12 ml
adult: 12-25 ml
girls peak height velocity
tanner stage 2-3
peak height velocity occurs before menarche
boys peak height velocity
tanner stage 4-5
t/f fusion of the epiphyses of the left hand is not a good indicator for further elongation
false, fusion of epiphyses in the left wrist and hand indicates no further elongation should be expected from the patient
___ in females leads to earlier breast development, pubic hair, or menarche
obesity
precocious puberty for f/m
f: before 8 yo
m: before 9 yo
delayed puberty for f/m
f: after 13 yo
m: after 14 yo
features of precocious puberty in girls
before 8 yo breast development (first sign) earlier growth spurt pubic and axillary hair menstruation
features of precocious puberty in boys
before 9 yo
enlargement of testes (first sign)
pigmentation of scrotum and penile growth
pubic and axillary hair, earlier growth spurt, acne and deepened voice
diagnostic tests for precocious puberty
bone age fsh, lh, estradiol for f baseline testosterone for m gnrh stimulation test 17-ohp, tsh, ft4, hcg pelvic and adrenal uts cranial mri/ct
result of gnrh stimulation test in central peripheral puberty
increased lh response
abnormal results of blood tests for precocious puberty
17-ohp: cah
tsh and ft4: thyroid
hcg: gonadotropin secreting tumor
imaging tests for precocious puberty
pelvic and adrenal uts: ovary pathology or adrenal tumor
mri: hypothalamic or pituitary tumor
classification of precocious puberty
central: gonadotropin dependent (true), hpg axis is activated
peripheral: gonadotropin independent
incomplete or partial pubertal development
causes of organic cns/brain lesion
hypothalamic hamartoma
secretory brain tumors
cns infections (encephalitis, tb meningitis)
factors that are more likely organic causes of central pp
boys (75%) and younger boys (< 6 yo)
girls with rapid breast development, estradiol > 30 pg/ml, < 6 yo