endocrinology of puberty Flashcards by Muambo Eko

define puberty in a nutshell

transition from sexual immaturity to sexual maturity.

achieving fertility, growth in stature and secondary sex characteristics

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what hormones controlling puberty are released in the brain

FSH, LH, GnRH, neuroendocrine

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what hormones contribute to female puberty

oestradiol, progesterone, adrenal androgen precursors

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what hormones contribute to male puberty

Testosterone
Dihydrotestosterone
(DHT)
Adrenal androgens
Oestradiol( don't overlook this for growth)

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define gonadarche

activation of gonads by fsh and lh

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define adrenarche

increase in androgen production by adrenal cortex

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define thelarche

appearance of breast tissue

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what causes thelarche

estrogen from ovaries

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define menarche

first menstrual bleed, non ovulatory

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define spermarche

first sperm production, nocturnal sperm emissions

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define pubarche

appearance of pubic hair, first appearance of axillary hair apocrine body odour and acne

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what does (estradiol/oestradiol/estrogen) all the same thing contribute to in puberty

breast devlopment, growth accelarator, skeletal maturation

menstruation along with progesterone

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At what point can hormones contributing to puberty be tested if mother is concerned about her child

best time is after birth where mini puberty of infancy occurs if this period is missed it is very hard to ascertain whether the hpa axis and gonads are communicating and functioning until expected start of puberty

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when do girls start puberty on average

8yrs

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what age do boys start puberty at

9 years

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what are tanner stage in regards to boys and girls

tanners stages are stages of development, for genitial changes in boys and breast growth in girls. 5 stages
considers pubic hair growth testicles descent and size, and breast growth

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what five factors contribute to timing of puberty

race, genetics, nutritional status, health, enviroment

what other medical changes can be associated with

acne, gynecomastia(breast development) , anaemia

define precocious puberty

when puberty starts early 2-2.5 standard deviations earlier than the norm. could be normal development or pathological cause

define true central precocious puberty and it’s key characteristics

Gonadotropin dependent
• Early maturation of the HPG axis
• Sequential maturation
sexual characteristics have to be appropriate for the child gender

define key characteristics of of peripheral precocity

Gonadotropin independent
• Excess of secretion of sex
hormones – gonads, adrenal
glands, exogenous sources of
sex steroids, ectopic production
of gonadotropin from a germ
cell tumour
• Non sequential maturation
• Isosexual or contrasexual

state 2 BENIGN

PUBERTAL VARIANTS

premature adrenarche and thelarche, they dont generally cause long term impact to puberty, isolated incident.

who is premature adrenarche (an example of a benign pubertal variant) more common in and what are potential risks and implications

afro carib and hispanic girls, can cause priming therefore risk of TCPP, also risk of PCOS in girls.

describe characteristics of premature thelarche(benign pubertal variant)

diopathic
• Around two years of age
• Waxes and wanes – Does not progress
• Isolated breast development / Not beyond Tanner stage 3
• Absence of other secondary sexual characteristics
• Normal height velocity for age
• Normal or near normal bone age
• LH and FSH between normal range

central precocious puberty what do you expect to find

advanced bone age, acclerated linear growth, pubertal levels of FSH and LH

What causes TCPP

can be idiopathic(no clue what did ) CNS lesion, trauma affecting homromnal axis as a result, genetic loss of function in MKRN3 or gain in KISS1 and KISS1r. Pituitary gonadotrophin secreting tumours

what causes periphial precocity in girls

ovarian cyst, ovarian tumours

CAUSES OF PERIPHERAL PRECOCITY - BOYS

leydig cell tumours, Mutation in Lh receptor gene causing lh cell to mature to quick, Familial male-limited precocious puberty (testotoxicosis) germ cell tumours (• Germ Cell tumours secrete hCG • hCG secretion activates LH receptors on Leydig cells Testosterone production • Located in gonads, brain, liver, retroperitoneum, anterior mediastinum • Testicular size smaller than expected for the testosterone concentration in plasma + pubertal staging)

what can cause peripheral precocity in both males and females

Primary hypothyroidism Exogenous sex steroids(creams or foods soya) adrenal pathology

what is mcune albright syndrome and it's symptoms

McCune Albright syndrome • Triad of peripheral precocious puberty, irregular café au lait spots, fibrous dysplasia of bone • Sequence of pubertal progression may be abnormal, often presenting with vaginal bleeding

how do you evaluate premature puberty clinically

first history and examination, then basal fsh and lh, oestradiol,testosterone thirdly gnrh stimulations and look at adrenal steroids in urine serum other studies beta hcg afp finally images of the brain, bone age and pelvic ultrasound

what are the potential treatments for premature puberty gonadtrophin dependent

depends on cause, gonadtrophin dependent block with Gnrh analogues,

what are the potential treatments for premature puberty gonadtrophin independent

treat with anti androgens if you can't treat or find the cause

what are the potential treatments for premature puberty is benign variance

just reassure family

what are the treatments and things that have to be considered when a child is expieriencing delayed puberty

watchful waiting (they may start growingand end up even taller than predicted), counselling if they are being bullied, anabolic steroids to increase growth, short term sex therapy to kickstart puberty

what gender is more affected by delayed puberty

boys

what can cause primary hypogonadism congenital and acquired causes

chromosomal abnormalities turner syndrome or kinefelter testicular regression, synthesis and action of sexual steroids acquired causes can be surgery, trauma, post infection, metabolic or chemo or radiation

what is the difference between primary and secondary hypogonadism

primary is issue with the gonad and secondary is issue with the hypothalamus

what can cause congential and acquired secondary hypogonadism

congential, gnrh deficit (expierienced in PWS, issues witrh receptors, Kallmans), idiopathic, midline defect or cranial anomaly acquired can be functional loss or physical

what are the conc of fsh and lh like in primary hypogonadism

elevated

how do you clinically recognise delayed puberty in girls 4 key points

13 no breast, 5 years between thelarche and menarche, no pubic haior by 14, no menarche by 16 no secondary sexual characteristics

how do you clinically recognise delayed puberty in boys 3 key points

Testicular volume less than 4 ml by age 14, no pubic hair by 15, more than 5 years to finish penile and testes growth