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Question 1

what is precocious puberty?

Answer 1

development of 2˚ sexual characteristics before 8 years in females and 9 years in males

Question 2

in whom is precocious puberty more common in?

Answer 2

females

Question 3

what are other terms used for precocious puberty?

Answer 3

• thelarche (1st stage of breast development)

- adrenarche (1st stage of pubic hair development)

Question 4

how may precocious puberty be classified into?

Answer 4

1. Gonadotrophin dependent (‘central’ ‘true’)

2. Gonadotrophin independent (‘pseudo’ ‘false’)

Question 5

what is Gonadotrophin dependent precocious puberty?

Answer 5

• due to premature activation of hypothalamic-pituitary-gonadal axis
• FSH and LH raised

Question 6

what is non-Gonadotrophin dependent precocious puberty?

Answer 6

• due to excess sex hormones

- low FSH and LH

Question 7

is precocious puberty in males common? what does it usually have?

Answer 7

uncommon, usually has an organic cause

Question 8

what is the cause of bilateral testes enlargement in males with precocious puberty?

Answer 8

gonadotrophin release from intracranial lesion

Question 9

what is the cause of unilateral testes enlargement in males with precocious puberty?

Answer 9

gonadal tumour

Question 10

what is the cause of small testes in males with precocious puberty?

Answer 10

adrenal causes (tumour or adrenal hyperplasia)

Question 11

what are the features of precocious puberty in females?

Answer 11

• usually idiopathic or familial
• follows normal sequence of puberty
• organic causes rare

Question 12

what are causes of delayed puberty with short stature?

Answer 12

1. Turner’s syndrome
2. Prader-Willi syndrome
3. Noonan’s syndrom

Question 13

what are causes of delayed puberty with normal stature?

Answer 13

1. PCOS
2. androgen insensitivity
3. Kallman’s syndrome
4. Klinefelter’s syndrome

Question 14

what is the first sign of puberty for males?

Answer 14

testicular growth at around 12 years of age (range 10-15)

Question 15

what indicates the onset of puberty for males?

Answer 15

testicular volume >4ml

Question 16

when is the maximum height spurt for males?

Answer 16

at 14

Question 17

what is the first sign of puberty for females?

Answer 17

breast development at around 11.5 years (range 9-13)

Question 18

when does a female reach maximum height spurt?

Answer 18

at 12, before menarche

only an increase of 4% of height following menarche

Question 19

when do females usually have menarche?

Answer 19

13 (range 11-15)

Question 20

what are some normal changes in puberty?

Answer 20

• gynaecomastia may develop in boys
• asymmetrical breast growth may occur in girls
• diffuse enlargement of the thyroid gland may be seen

Question 21

what is the most common cause of hypothyroidism (juvenile hypothyroidism) in children?

Answer 21

autoimmune thyroiditis

Question 22

what are the other causes of juvenile hypothyroidism?

Answer 22

• post-total body irradiation e.g. in a child previously rx for ALL
• iodine deficiency (most common cause in developing world)