Endocrinology- Puberty, Metabolism and other hormones

Question 1

Define Precocious puberty. What is the initial evaluation

Answer 1

Onset of secondary sexual characteristics (breast tissue, acne, pubic/axillary hair) in girls <8 and boys <9.

Bone age evaluation to asses skeletal maturation is initial assessment

Question 2

what are precocious puberty signs of excess androgens

Answer 2

acne
body odor
axillary and pubic hair

Question 3

what are precocious puberty signs of excess estrogen

Answer 3

breast development
Vaginal bleedings
Premature epiphyseal fusion
advanced bone age

Question 4

When would abdomina/ pelvic U/S be indicated for precocious puberty?

Answer 4

Concern for peripheral production of endogenous hormones (ovarian/ adrenal tumor).

Findings: advance bone age with suppressed LH& FSH levels

Question 5

Hypothyroidism and precocious puberty

Answer 5

TSH activates FSH receptor–> increased estrogen.

Presents with signs of hypothyroidism, great tissue, vaginal bleeding.

Question 6

Diagnosis: Precocious puberty, normal bone age, pubic hair, obesity

Answer 6

Premature adrenarche

Early activation of adrenal androgens: Adipose tissue –> XS insulin –> adrenal glands produce ↑ sex hormones

Question 7

Diagnosis: precocious puberty, advanced bone age, elevated FAH and LH

Answer 7

Central precocious puberty

Question 8

causes of central precocious puberty

Answer 8

hypothalmic glioma,
pituitary hamartoma,
pituitary microadenoma
Idiopathic precocious puberty

Question 9

Test for central precocious puberty

Answer 9

LH elevated at basal or becomes elevated after GnRH stimulation.

Question 10

Diagnosis: precocious puberty, advance bone age, low LH even with stimulation

Answer 10

Peripheral precocious puberty

Question 11

Causes of peripheral precocious puberty

Answer 11

non classic congenital adrenal hyperplasia

congenital adrenal hyperplasia

Question 12

Mechanism of [nonclassic] congenital adrenal hyperplasia in precocious puberty

Answer 12

21-hydroxylase deficiency impart conversions of 17-hydrxyprogesterone to 11-deoxycortisol.

17-hydroxyprogesterone is shunted toward adrenal androgen over production

Question 13

Key findings of non classic congenital adrenal hyperplasia

Answer 13

in non classic CAH sufficient glucocorticoid and mineralocorticoid levels are maintained therefore patients have normal electrolytes

Question 14

PCOS malignancy risk

Answer 14

Decreased progesterone due to chronic anovulatory cycles causes unbalanced endometrium proliferation by estrogens.

Increased risk for endometrial hyperplasia and cancer

Question 15

S&S refeeding syndrome

Answer 15

Arrhythmia 
CHF
Pulmonary edema 
Peripheral edema
Seizures 
Wernikie encephalopathy

Question 16

mechanism of refeeding syndrome

Answer 16

Increased insulin activity causes electrolyte derangement as the body shifts from prolonged catabolism to anabolism.

Increased cellular uptake of phosphorous (main deficient), K and Mg.