EXAM #1: PUBERTY/ ADOLESCENT GYN

Question 1

What is adrenarche?

Answer 1

Secretion of sex steroids from the zona reticularis in the adrenal gland

*Occurs between 6-8

Question 2

What is gonadarche?

Answer 2

Pulsatile GnRH secretion from hypothalamus

*Occurs around age 8

Question 3

What is thelarche?

Answer 3

Breast bud development; first phenotypic sign of puberty

*Comes from estrogen

Question 4

What is pubarche?

Answer 4

Onset of pubic hair growth

• Accompanied by axillary hair growth
• Androgen induced

Question 5

When does normal menarche occur?

Answer 5

12-13 y/o

*Note that this can be irregular at first, which is normal

Question 6

What hormone is specifically increased by FSH?

Answer 6

Estrogen secretion from the ovaries

Question 7

What hormones are specifically increased by LH?

Answer 7

Progesterone and androgen secretion from the ovaries

Question 8

What pre-pubertal morphological changes occur in girls?

Answer 8

1) Increased ovary size
2) Vaginal lengthening
3) Uterine:cervix ratio increases

Question 9

What hormone does estrogen have a positive feedback on?

Answer 9

LH

Question 10

What hormone does estrogen have negative feedback on?

Answer 10

FSH

Question 11

When is the growth peak in girls?

Answer 11

• Roughly 2 years after breast budding

- 1 year prior to menarche

Question 12

What is the major determinant for the timing of puberty?

Answer 12

Genetics

Question 13

What are the minor determinants for the timing of puberty?

Answer 13

1) Nutritional status
2) General health
3) Geography

Question 14

What is precocious puberty/ how is it defined?

Answer 14

• Breast development before 7
• Pubic hair before 8
• Menstruation before 10

Question 15

What causes true precocious puberty?

Answer 15

Early GnRH activation

Question 16

What causes pseudo-precocious puberty?

Answer 16

GnRH independent production of sex hormones caused by:

1) Ovarian cyst
2) McCune Albright Syndrome
3) Adrenal tumor
4) Hormones in supplements

Question 17

What is McCune-Albright Syndrome?

Answer 17

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Question 18

What are the goals of treatment in precocious puberty?

Answer 18

Arrest and diminish sexual maturation

Question 19

What is the treatment of choice for precocious puberty?

Answer 19

GnRH agonists i.e. Leuprolide given continuously

Question 20

What do you want to do in the workup of precocious puberty?

Answer 20

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

Question 21

In girls that undergo precicious puberty, what are they at risk for?

Answer 21

Breast cancer later in life

Question 22

What is the definition of delayed puberty?

Answer 22

• No secondary sex characteristics by 13
• No menarche by 15-16
• No menses within 5 years of telarche (breast bud development)

Question 23

What is the most common cause of delayed puberty?

Answer 23

Hypergonadotropic Hypogonadism i.e. Turner’s Syndrome (XO)

*Characterized by “streak” ovaries without ovarian follicles

Question 24

What hormone levels are expected in Hypergonadotropic Hypogonadism?

Answer 24

High LH/FSH

Question 25

How is Hypergonadotropic Hypogonadism treated?

Answer 25

1) Growth hormone
2) Estrogen administration
3) Pregestins at Tanner IV

Question 26

What is Hypogonadotropic Hypogonadism?

Answer 26

Delayed sexual development with low normal levels of LH/FSH

*Most commonly this is simple constitutional delay

Question 27

What is Kallmann Syndrome?

Answer 27

Hypothalamic neurons fail to migrate into the hypothalamus during embryonic development. Presents with:

1) Delayed puberty
2) Anosmia

Question 28

How is Kallmann Syndrome treated?

Answer 28

Pulsatile GnRH agonist

Question 29

What is the most common cause of primary amenorrhea in women with normal breast development?

Answer 29

Mullerian agenesis i.e. congenital absence of vagina, uterus, and fallopian tubes

Question 30

How does an imperforate hymen present?

Answer 30

Bulging blue mass and pelvic pain

Question 31

What is the definitive treatment for an imperforate hymen?

Answer 31

Hymenotomy

Question 32

What is Tanner Stage I?

Answer 32

• Elevation of nipple

- No pubic hair

Question 33

What is Tanner Stage II?

Answer 33

• Elevation of breast bud

- Long spare pubic hair

Question 34

What is Tanner Stage III?

Answer 34

• Enlargement of breast and areola

- Darker/ coarser hair

Question 35

What is Tanner Stage IV?

Answer 35

• Projection of papilla and areola as a secondary mound

- Adult hair but only on the mons; not on the thighs

Question 36

What is Tanner Stage V?

Answer 36

• Recession of the areola to normal mature contour

- Adult inverse triangle and medial thighs