EXAM #1: PUBERTY/ ADOLESCENT GYN Flashcards
What is adrenarche?
Secretion of sex steroids from the zona reticularis in the adrenal gland
*Occurs between 6-8
What is gonadarche?
Pulsatile GnRH secretion from hypothalamus
*Occurs around age 8
What is thelarche?
Breast bud development; first phenotypic sign of puberty
*Comes from estrogen
What is pubarche?
Onset of pubic hair growth
- Accompanied by axillary hair growth
- Androgen induced
When does normal menarche occur?
12-13 y/o
*Note that this can be irregular at first, which is normal
What hormone is specifically increased by FSH?
Estrogen secretion from the ovaries
What hormones are specifically increased by LH?
Progesterone and androgen secretion from the ovaries
What pre-pubertal morphological changes occur in girls?
1) Increased ovary size
2) Vaginal lengthening
3) Uterine:cervix ratio increases
What hormone does estrogen have a positive feedback on?
LH
What hormone does estrogen have negative feedback on?
FSH
When is the growth peak in girls?
- Roughly 2 years after breast budding
- 1 year prior to menarche
What is the major determinant for the timing of puberty?
Genetics
What are the minor determinants for the timing of puberty?
1) Nutritional status
2) General health
3) Geography
What is precocious puberty/ how is it defined?
- Breast development before 7
- Pubic hair before 8
- Menstruation before 10
What causes true precocious puberty?
Early GnRH activation
What causes pseudo-precocious puberty?
GnRH independent production of sex hormones caused by:
1) Ovarian cyst
2) McCune Albright Syndrome
3) Adrenal tumor
4) Hormones in supplements
What is McCune-Albright Syndrome?
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What are the goals of treatment in precocious puberty?
Arrest and diminish sexual maturation
What is the treatment of choice for precocious puberty?
GnRH agonists i.e. Leuprolide given continuously
What do you want to do in the workup of precocious puberty?
1) Bone age
2) Vaginal smear for estrogen effect
3) LH, FSH, estradiol, DHEA, TSH, 17OHP
4) CT/MRI
5) US for assessment of ovarian masses
*Refer to peds endocrine
In girls that undergo precicious puberty, what are they at risk for?
Breast cancer later in life
What is the definition of delayed puberty?
- No secondary sex characteristics by 13
- No menarche by 15-16
- No menses within 5 years of telarche (breast bud development)
What is the most common cause of delayed puberty?
Hypergonadotropic Hypogonadism i.e. Turner’s Syndrome (XO)
*Characterized by “streak” ovaries without ovarian follicles
What hormone levels are expected in Hypergonadotropic Hypogonadism?
High LH/FSH
How is Hypergonadotropic Hypogonadism treated?
1) Growth hormone
2) Estrogen administration
3) Pregestins at Tanner IV
What is Hypogonadotropic Hypogonadism?
Delayed sexual development with low normal levels of LH/FSH
*Most commonly this is simple constitutional delay
What is Kallmann Syndrome?
Hypothalamic neurons fail to migrate into the hypothalamus during embryonic development. Presents with:
1) Delayed puberty
2) Anosmia
How is Kallmann Syndrome treated?
Pulsatile GnRH agonist
What is the most common cause of primary amenorrhea in women with normal breast development?
Mullerian agenesis i.e. congenital absence of vagina, uterus, and fallopian tubes
How does an imperforate hymen present?
Bulging blue mass and pelvic pain
What is the definitive treatment for an imperforate hymen?
Hymenotomy
What is Tanner Stage I?
- Elevation of nipple
- No pubic hair
What is Tanner Stage II?
- Elevation of breast bud
- Long spare pubic hair
What is Tanner Stage III?
- Enlargement of breast and areola
- Darker/ coarser hair
What is Tanner Stage IV?
- Projection of papilla and areola as a secondary mound
- Adult hair but only on the mons; not on the thighs
What is Tanner Stage V?
- Recession of the areola to normal mature contour
- Adult inverse triangle and medial thighs
